CPT 64615 · Botulinum Toxin · AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices
Botox — Chronic Migraine Chemodenervation at AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices.
How AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices approaches CPT 64615 (Botox — Chronic Migraine 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 AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices policy of record for CPT 64615. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
Source: AC Family Provider Manual / Medical Drug PA — Botulinum Toxin Chemodenervation
See the full AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices criteria.
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