CPT 64647 · Botulinum Toxin · Molina Healthcare of Florida
Botox — Trunk/Axial Chemodenervation (6+ muscles) at Molina Healthcare of Florida.
How Molina Healthcare of Florida 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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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-06
Policy number
Molina MCP — Botulinum ToxinCriteria summary
High-level themes from the Molina Healthcare of Florida 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.
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