CPT 64612 · Botulinum Toxin · UnitedHealthcare Community Plan of Maryland
Botox — Hemifacial Chemodenervation at UnitedHealthcare Community Plan of Maryland.
How UnitedHealthcare Community Plan of Maryland approaches CPT 64612 (Botox — Hemifacial Chemodenervation) for prior-authorization review: at last review on 2026-04-27, the policy covers this code with prior authorization required.
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UHC CP-MD Provider ManualCriteria summary
High-level themes from the UnitedHealthcare Community Plan of Maryland 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: UnitedHealthcare Community Plan of Maryland — Care Provider Manual (2025/2026)
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