Botulinum Toxin Injections: New Policy Update
The Local Coverage Determination (LCD) DL39909 for Botulinum Toxin Injections will start on January 1, 2026. The new policy will take effect on February 15, 2026. WPS worked with other MACs to create this update.
The use of Botulinum toxin to treat conditions is growing. This new LCD addresses the need to update our current policy with the latest evidence and practice guidance.
Why Is This Important?
This new policy covers more than a dozen different conditions as well as multiple medical specialties and practice types. The policy includes over 330 articles and resources that support the changes.
You should know that the MACs received and reviewed thousands of comments during the open comment period. These comments helped shape the policy changes.
Because this policy could change how Botox services are approved and paid for, you need to stay informed. Following the new guidelines will help avoid claim denials.
What You Need to Do
After you read the Coverage Guidance, focus on the conditions you treat most often. Pay attention to the following details for each condition:
You will also need to document progress with an objective scale at each visit. This helps show how the treatment works.
Make sure to keep clear records if you change a patient’s treatment plan. This includes things like increasing the dose or changing how often you inject Botox.
Who Is Affected?
The biggest impact will be on Hospital Outpatient Departments (HOPDs) and Physicians who are involved in Prior Authorization (PA). You need to prepare for changes in the way Botox claims are processed. These changes will directly affect PA requests for specific CPT codes:
Next Steps
If your hospital or practice provides Botox services that are part of Medicare’s prior authorization process, make sure you attend the WPS webinar about these changes. It is important to understand the new rules to avoid payment delays or denials.
February 2026 Local Coverage Determination (LCD) and Billing and Coding Article Updates
We updated the following Local Coverage Determinations (LCDs) and Billing and Coding Articles for February 2026. The full article on our website details additional information on these updates.
Please note: Our LCDs and Billing and Coding/Coverage articles will reflect these changes on January 29, 2026.
New Policies/Articles - We created the following new policies/articles for February 2026 - Effective March 1, 2026
Billing and Coding: Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)
Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)
Retired Policies/Articles – We retired no policies/articles for February 2026.
Revised Policies/Articles – We revised the following policies/articles for February 2026 – Effective as Indicated
2026 CPT/HCPCS Code Updates – Effective January 1, 2026
Billing and Coding: Category III Codes – Effective January 1, 2026
Billing and Coding: Intraarticular Knee Injections of Hyaluronan – Effective January 1, 2026
Billing and Coding: MolDx: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer – Effective January 1, 2026
Billing and Coding: MolDx: Minimal Residual Disease Testing for Solid Tumor Cancers – Effective January 1, 2026
Billing and Coding: MolDx: Molecular Diagnostic Tests (MDT) – Effective April 17, 2026
Billing and Coding: MolDx: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing – Effective January 1, 2026
Billing and Coding: MolDx: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies – Effective January 1, 2026
Billing and Coding: MolDx: Pharmacogenomics Testing – Effective January 1, 2026
Category III Codes – Effective January 1, 2026
Urine Drug Testing – Effective January 1, 2026