CPT 64647 · Botulinum Toxin · Health Partners Plans / Jefferson Health Plans — PA HealthChoices
Botox — Trunk/Axial Chemodenervation (6+ muscles) at Health Partners Plans / Jefferson Health Plans — PA HealthChoices.
How Health Partners Plans / Jefferson Health Plans — PA HealthChoices approaches CPT 64647 (Botox — Trunk/Axial Chemodenervation (6+ 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 Health Partners Plans / Jefferson Health Plans — PA HealthChoices policy of record for CPT 64647. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
See the full Health Partners Plans / Jefferson Health Plans — PA HealthChoices criteria.
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