Avoiding Non Affirmed Prior Authorizations of Botulinum Toxin

This is a recording of a live event that took place on 8/20/2026. Prior Authorization requests for Botulinum Toxin in the hospital outpatient department continue to be the highest non-affirmed prior authorization requests. In this webinar we covered: Reasons for non-affirmed decisions Documentation necessary to support requests Upcoming changes Resources: Botulinum Toxin Injection LCD L39909: https://www.cms.gov/medicare-coverage... Billing and Coding: Botulinum Toxin Injections A59809: https://www.cms.gov/medicare-coverage... Federal Register Proposed Final Rule 07/07/2026: https://www.federalregister.gov/docum... CMS Internet-Only Manual Publication 100-02, Medicare Benefit Policy Manual, Chapter 16 - General Exclusions From Coverage: https://www.cms.gov/Regulations-and-G... Prior Authorization for Hospital Outpatient Department Services (HOPD) Overview: https://www.wpsgha.com/guides-resourc... Hospital Outpatient Department (HOPD) Prior Authorization Request Form: https://www.wpsgha.com/forms/view/673 Chapters: 00:00 Opening 00:37 Objective and Agenda 01:31 Reasons for Non-Affirmed Decisions & Knowledge Checks 16:24 Documentation 19:30 Blepharospasm Documentation 25:15 Cervical Dystonia (Spasmodic Torticollis) Documentation 31:02 Migraine Documentation 39:25 Hemifacial Spasm/Facial Dystonia Documentation 42:21 New Prior Authorization Codes for 2027 46:06 Changes in the LCD 53:18 Resources 57:04 Questions and Answers 1:23:48 Closing Remarks