Earlier this year, AAPM&R mobilized in response to five Medicare Administrative Contractors (MACs) releasing draft local coverage determinations (LCDs) which would significantly restrict coverage for botulinum toxin injections for spasticity and other conditions. The Academy engaged with the MACs in opposition to these proposed policies and we are now awaiting final versions of the LCDs. 

This month, the two MACs that did not release draft LCDs earlier this year, Novitas and First Coast Service Options, have now released their draft LCDs on botulinum toxin.  AAPM&R is in the process of reviewing these new draft LCDs as well as the associated Coding and Billing Articles, which are linked below.

First Coast
Botulinum Toxin Draft LCD
Draft Coding and Billing Article

Novitas
Botulinum Toxin Draft LCD
Draft Coding and Billing Article
 

We will be working with member experts in spasticity management to craft responses to the drafts by the November 23 comment deadline. We encourage members who treat patients in the First Coast or Novitas jurisdictions to submit comments as well.