CPT 64612 · Botulinum Toxin · Wellpoint Maryland
Botox — Hemifacial Chemodenervation at Wellpoint Maryland.
How Wellpoint 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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CG-DRUG-31 / DRUG.00003Criteria summary
High-level themes from the Wellpoint 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: Anthem Medical Policy CG-DRUG-31 / DRUG.00003 — Botulinum Toxin
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