Rubrica

CPT 64646 · Botulinum Toxin · Highmark Wholecare — PA HealthChoices

Botox — Trunk/Axial Chemodenervation (1–5 muscles) at Highmark Wholecare — PA HealthChoices.

How Highmark Wholecare — PA HealthChoices approaches CPT 64646 (Botox — Trunk/Axial Chemodenervation (1–5 muscles)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.

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Coverage Covered
Prior auth Prior auth required
Last reviewed 2026-05-06
Policy numberHealthHelp IPM — Botulinum Toxin Chemodenervation

Criteria summary

High-level themes from the Highmark Wholecare — PA HealthChoices policy of record for CPT 64646. Verbatim policy text and per-criterion analysis are available after sign-in.

Source: Highmark Wholecare PA Medicaid Prior Authorization List (eff 05/01/2026) — Botulinum Toxin (HealthHelp + Pharmacy review)

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