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Gastroenterology Coding Alert

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Botox Can Mean Reimbursement When Used as a Chemodenervating Agent

Question: Our gastroenterologist has recently begun using Botox in patients who are seen for strictures of the esophagus, gastroparesis, achalasia and such conditions. I need to know if Medicare and other insurance companies cover such a treatment using Botox. Colorado Subscriber Answer: Medicare and other insurance carriers will not cover Botox if it is used for any cosmetic reasons without any medical necessity apart from improving one's esthetic appearance. But if Botox is used for a purpose as mentioned by you in the treatment of a condition like achalasia, gastroparesis or to relieve strictures in the esophagus using forms of Botox injections such as Botox A or Botox R, you can receive reimbursements from Medicare and other insurance payers. By using Botox, your gastroenterologist is trying to cause a process known as chemodenervation that will help in inducing paralysis of the muscle. Since there is no definite CPT® code for [...]

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