CPT 64612 · Botulinum Toxin · Ohio Medicaid
Botox — Hemifacial Chemodenervation at Ohio Medicaid.
How Ohio Medicaid approaches CPT 64612 (Botox — Hemifacial Chemodenervation) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Criteria summary
High-level themes from the Ohio Medicaid policy of record for CPT 64612. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: Ohio Medicaid Interventional Pain Management Coverage Guidelines
See the full Ohio Medicaid criteria.
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