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  • Prior Authorization Form Botulinum Toxins - Independence Blue Cross

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Independence Blue Cross offers products directly, through its subsidiaries ... Prior Authorization Form Botulinum Toxins ... Provider Information (please print).

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All requests for (onabotulinumtoxinA) require a prior authorization and will be screened for medical necessity and appropriateness using the criteria listed below.

procedure is usually a separate visit These are billed as 64615 (or other procedure code depending upon the area where the injections are given) and include the code J0585 with the amount of given to the patient.

HCPCS II. J0585a. INJECTION, ONABOTULINUMTOXINA, 1 UNIT. NDC. 00023-1145-01b. ® 100 Unit vial. 00023-3921-02b. ® 200 Unit vial.

type A (®) (onabotulinumtoxinA), is supplied in 100-unit vials, and is billed “per unit.” Claims for (onabotulinumtoxinA), should be submitted under HCPCS code J0585.

Example For HCPCS procedure code J0585 (Injection, onabotulinumtoxinA, 1 unit), 200 units would be indicated (including the 45 units of waste). For NDC N400023392102 UN1, one unit would be indicated (representing the number of 200-unit vials used).

HCPCS code J0585 for Injection, onabotulinumtoxinA, 1 unit as maintained by CMS falls under Drugs, Administered by Injection .

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232