botox injections in leg muscle after stroke side effects

Member is diagnosed with blepharospasm including blepharospasm associated with dystonia, benign essential blepharospasm or VII nerve disorder.Member is 12 years of age or older and.

Treatment of blepharospasm when all of the following are met: Treatment of chronic anal fissures when the member has not responded to first line therapy such as topical calcium channel blockers or topical nitrates Treatment of achalasia when the member has tried and failed or is a poor candidate for conventional therapy such as pneumatic dilation and surgical myotomy First bite syndrome: neurologist or oncologist.Īetna considers onabotulinumtoxinA (Botox) medically necessary for any of the following indications:.Excessive salivation, spasmodic dystonia, oromandibular dystonia, bruxism, palatal myoclonus: neurologist or otolaryngologist.Chronic anal fissures, achalasia, Hirschsprung disease: gastroenterologist, proctologist or colorectal surgeon.Migraine prophylaxis, tremor, orofacial tardive dyskinesia: neurologist.Hyperhidrosis: neurologist or dermatologist.Spasticity, cervical dystonia, hemifacial spasm, myofascial pain syndrome, focal hand dystonia, facial myokymia: neurologist, orthopedist, or physiatrist.Overactive bladder, urinary incontinence: neurologist or urologist.

Blepharospasm, strabismus: neurologist or ophthalmologist.

The medication must be prescribed by, or in consultation with, one of the following:

OnabotulinumtoxinA (Botox Brand of Botulinum Toxin Type A).

For precertification of botulinum toxin (Botox Dysport Myobloc and Xeomin ), call (866) 752-7021 (commercial), or fax (888) 267-3277. For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification.įor Medicare Part B plans, call (866) 503-0857, or fax (844) 268-7263. Precertification of botulinum toxin (Botox Dysport Myobloc and Xeomin ) is required of all Aetna participating providers and members in applicable plan designs.

Dysport is contraindicated for the member.

Inadequate response to a trial of Dysport.

Xeomin is contraindicated for the member.

Inadequate response to a trial of Xeomin.

Dysport or Xeomin is contraindicated for the member.

Intolerable adverse event to Dysport or Xeomin.

Inadequate response to a trial of Dysport or Xeomin.

Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background Referencesīotox and Myobloc, for the indications listed below:Īre not covered for new starts, unless the member meets ANY of the following:

Botox injections in leg muscle after stroke side effects