Rubrica

CPT 64612 · Botulinum Toxin · Sunshine Health (Centene) — Florida Medicaid

Botox — Hemifacial Chemodenervation at Sunshine Health (Centene) — Florida Medicaid.

How Sunshine Health (Centene) — Florida 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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Coverage Covered
Prior auth Prior auth required
Last reviewed 2026-05-06
Policy numberInterQual / Sunshine Pharmacy PA

Criteria summary

High-level themes from the Sunshine Health (Centene) — Florida 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: Sunshine Health FL Medicaid — InterQual botulinum toxin chemodenervation criteria; J0585 drug requires separate FL Medicaid pharmacy-channel PA via Magellan PDL

See the full Sunshine Health (Centene) — Florida Medicaid criteria.

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