CPT 64615 · Botulinum Toxin
Botox — Chronic Migraine Chemodenervation
Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (e.g., chronic migraine).
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Rubrica tracks payor coverage for CPT 64615 (Botox — Chronic Migraine Chemodenervation) across 76 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 64615
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| Aetna | Covered | Prior auth |
| Aetna Better Health of Florida | Covered | Prior auth |
| Aetna Better Health of Maryland | Covered | Prior auth |
| Aetna Better Health of New Jersey | Covered | Prior auth |
| Aetna Medicare Advantage | Covered | Prior auth |
| Alabama Medicaid | Covered | Prior auth |
| Alabama Medicaid (FFS) | Covered | Prior auth |
| Allstate Auto / PIP | Covered | Prior auth |
| AmTrust Financial WC | Covered | Prior auth |
| AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices | Covered | Prior auth |
| Anthem BCBS | Covered | Prior auth |
| California Medicaid (Medi-Cal) | Covered | Prior auth |
Coverage themes for CPT 64615
Common patterns across the 76 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥8 weeks of conservative care before approving 64615.
2 of 76 payors require imaging concordance documentation.
Of the 76 payors with coverage records for CPT 64615, 49 require prior authorization, 26 cover without prior authorization, and 0 flag the procedure as investigational or experimental under current criteria.
See the policy for every payor.
Sign in to see verbatim coverage criteria, conservative-care duration requirements, imaging concordance rules, and the documentation each payor wants in the submission.
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