CPT 64615 · Botulinum Toxin · Wellpoint Maryland
Botox — Chronic Migraine Chemodenervation at Wellpoint Maryland.
How Wellpoint Maryland 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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CG-DRUG-31 / DRUG.00003Criteria summary
High-level themes from the Wellpoint Maryland policy of record for CPT 64615. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 16 weeks of conservative care typically required.
Source: Anthem Medical Policy CG-DRUG-31 / DRUG.00003 — Botulinum Toxin (Chronic Migraine)
See the full Wellpoint Maryland criteria.
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