CPT 64615 · Botulinum Toxin · Priority Partners MCO
Botox — Chronic Migraine Chemodenervation at Priority Partners MCO.
How Priority Partners MCO approaches CPT 64615 (Botox — Chronic Migraine 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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Criteria summary
High-level themes from the Priority Partners MCO 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: Priority Partners (JHHC) — Maryland Medicaid (Pharmacy/Medical Drug PA)
See the full Priority Partners MCO criteria.
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