CPT 64646 · Botulinum Toxin · Maryland Physicians Care
Botox — Trunk/Axial Chemodenervation (1–5 muscles) at Maryland Physicians Care.
How Maryland Physicians Care 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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Criteria summary
High-level themes from the Maryland Physicians Care policy of record for CPT 64646. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
Source: Maryland Physicians Care — Maryland Medicaid (Medical Drug PA)
See the full Maryland Physicians Care criteria.
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