Rubrica

CPT 64647 · Botulinum Toxin · Sunshine Health (Centene) — Florida Medicaid

Botox — Trunk/Axial Chemodenervation (6+ muscles) at Sunshine Health (Centene) — Florida Medicaid.

How Sunshine Health (Centene) — Florida Medicaid 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 numberInterQual / Sunshine Pharmacy PA

Criteria summary

High-level themes from the Sunshine Health (Centene) — Florida Medicaid policy of record for CPT 64647. Verbatim policy text and per-criterion analysis are available after sign-in.

Source: Sunshine Health FL Medicaid — InterQual botulinum toxin chemodenervation criteria; J0585 drug requires separate FL Medicaid pharmacy-channel PA via Magellan PDL

See the full Sunshine Health (Centene) — Florida Medicaid criteria.

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