`J0585` Injection,onabotulinumtoxina

Injection, onabotulinumtoxina, 1 unit

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 800 units per day (clinical), rationale: Clinical: Data
Outpatient hospital: max 800 units per day (clinical), rationale: Clinical: Data
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for J0585

Medicare Part B drug payment limit (ASP, October 2026)

J0585 payment limit: $6.514 per 1 UNIT, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J0585 (CMS ASP NDC-HCPCS crosswalk, October 2026)

00023-1145-01 Botox, Allergan, Inc.: 100 billing units per package (1 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL)
00023-3921-02 Botox, Allergan, Inc.: 200 billing units per package (1 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL)
00023-3919-50 Botox Cosmetic, Allergan, Inc.: 50 billing units per package (1 VIAL, GLASS in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, GLASS)
00023-9232-01 Botox Cosmetic, Allergan, Inc.: 100 billing units per package (1 VIAL, GLASS in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, GLASS)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J0585

110 of 111 payer prior-auth lists that name J0585 require prior authorization or set conditions: Aetna, Arkansas Blue Cross and Blue Shield, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Texas, Blue Shield of California Promise Health Plan, Cigna, HealthSpring, Humana, Medicare, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Arkansas Blue Cross and Blue Shield	Drugs under the medical benefit (not ASE/PSE or FEP, which use EBRx and Prime)	AR	prior auth required		Apr 1, 2022	Medical Benefit Pharmacy Prior Approval List
Blue Cross Blue Shield of Arizona (AZ Blue)	AZ Blue-administered Medicare Advantage (M2K)	AZ	prior auth required	Step therapy	Sep 1, 2026	AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Standard PA code list (most commercial plans)	AZ	prior auth required	eviCore-delegated groups	Sep 1, 2026	AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Standard PA code list (most commercial plans)	AZ	prior auth required	Other groups: AZ Blue	Sep 1, 2026	AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	State of Arizona employee group (SYD, S3Z)	AZ	prior auth required		Sep 1, 2026	State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Teamsters group (TYW)	AZ	prior auth required		Sep 1, 2026	Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026)
Blue Shield of California Promise Health Plan	Promise Health Plan Medi-Cal	CA	prior auth required		Sep 1, 2026	Medi-Cal Prior Authorization List
Medicare	Prior Authorization Demonstration for Certain ASC Services	AZ	prior auth under conditions	Only when billed with 64612 or 64615	Feb 16, 2026	List of Ambulatory Surgical Center Services For Prior Authorization
Medicare	Prior Authorization Demonstration for Certain ASC Services	CA	prior auth under conditions	Only when billed with 64612 or 64615	Jan 19, 2026	List of Ambulatory Surgical Center Services For Prior Authorization
Medicare	Prior Authorization Demonstration for Certain ASC Services	FL	prior auth under conditions	Only when billed with 64612 or 64615	Jan 19, 2026	List of Ambulatory Surgical Center Services For Prior Authorization
Medicare	Prior Authorization Demonstration for Certain ASC Services	GA	prior auth under conditions	Only when billed with 64612 or 64615	Jan 19, 2026	List of Ambulatory Surgical Center Services For Prior Authorization
Medicare	Prior Authorization Demonstration for Certain ASC Services	MD	prior auth under conditions	Only when billed with 64612 or 64615	Jan 19, 2026	List of Ambulatory Surgical Center Services For Prior Authorization
Medicare	Prior Authorization Demonstration for Certain ASC Services	NY	prior auth under conditions	Only when billed with 64612 or 64615	Jan 19, 2026	List of Ambulatory Surgical Center Services For Prior Authorization
Medicare	Prior Authorization Demonstration for Certain ASC Services	OH	prior auth under conditions	Only when billed with 64612 or 64615	Feb 16, 2026	List of Ambulatory Surgical Center Services For Prior Authorization
Medicare	Prior Authorization Demonstration for Certain ASC Services	PA	prior auth under conditions	Only when billed with 64612 or 64615	Jan 19, 2026	List of Ambulatory Surgical Center Services For Prior Authorization
Medicare	Prior Authorization Demonstration for Certain ASC Services	TN	prior auth under conditions	Only when billed with 64612 or 64615	Jan 19, 2026	List of Ambulatory Surgical Center Services For Prior Authorization
Medicare	Prior Authorization Demonstration for Certain ASC Services	TX	prior auth under conditions	Only when billed with 64612 or 64615	Feb 16, 2026	List of Ambulatory Surgical Center Services For Prior Authorization
Medicare	Prior Authorization for Certain Hospital OPD Services	All	prior auth under conditions	Only when billed with 64612 or 64615	Jul 1, 2020	Prior Authorization (PA) Program for Certain Hospital OPD Services Operational Guide, Appendix A
Aetna	Commercial	All	prior auth required		Oct 1, 2026	Participating provider precertification list for Aetna®
Cigna	ACA/IFP	All	prior auth required		Oct 1, 2006	Master Precertification List (For Health Care Providers)
Cigna	Basic Standard	All	prior auth required		Oct 1, 2006	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required		Oct 1, 2006	Master Precertification List (For Health Care Providers)
Blue Cross and Blue Shield of Illinois	Blue Cross Community Health Plans (BCCHP), Illinois Medicaid	IL	prior auth required		Jan 1, 2026	Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026
Blue Cross and Blue Shield of Illinois	Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative)	IL	prior auth required	eviCore-managed	Jan 1, 2025	Procedure Code List, Effective 1/1/2025
Blue Cross and Blue Shield of New Mexico	Turquoise Care (New Mexico Medicaid)	NM	prior auth required		Oct 1, 2026	New Mexico Medicaid Benefit Preauthorization Procedure Code List 10/1/26
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
HealthSpring	Medicare Advantage	All	prior auth required		Jan 1, 2025	2026 Q4 Prior Authorization List
Humana	Humana D-SNP (FL)	FL	prior auth required		Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (MI)	MI	prior auth required		Oct 14, 2026	Humana Dual Integrated (health maintenance organization Dual Eligible Special Needs Plan (HMO D- SNP) Michigan prior authorization and notification list (PAL)
Humana	Humana D-SNP (SC)	SC	prior auth required		Jul 1, 2026	Humana Dual Integrated South Carolina prior authorization and notification list
Humana	Humana D-SNP (VA)	VA	prior auth required		Jul 1, 2026	Prior authorization and notification list Humana Dual Fully Integrated H2875-001 (Virginia) Humana Dual Fully Integrated H2875-003 (Virginia)
Humana	Humana Healthy Horizons	FL	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Florida Prior Authorization and Notification List
Humana	Humana Healthy Horizons	KY	prior auth required		Oct 7, 2026	Humana Healthy Horizons in Kentucky Prior Authorization and Notification List
Humana	Humana Healthy Horizons	LA	prior auth required		Oct 14, 2026	Humana Healthy Horizons in Louisiana Prior Authorization and Notification List
Humana	Humana Healthy Horizons	OH	prior auth required		Oct 14, 2026	Humana Healthy Horizons in Ohio prior authorization and notification List
Humana	Humana Healthy Horizons	OK	prior auth required		Oct 14, 2026	Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List
Humana	Humana Healthy Horizons	SC	prior auth required		Oct 14, 2026	Humana Healthy Horizons in South Carolina prior authorization and notification list
Humana	Humana Healthy Horizons	VA	prior auth required		Oct 14, 2026	Humana Healthy Horizons in Virginia professionally administered medication prior authorization and notification list
Molina Complete Care (Virginia)	Medicare-only PA matrix for D-SNP	VA	prior auth required		Jan 1, 2022	Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022
Molina Complete Care (Virginia)	Medicaid	VA	prior auth required		Apr 1, 2025	Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of Arizona	Medicare-only PA matrix for D-SNP	AZ	prior auth required		Jan 1, 2022	Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022
Molina Healthcare of California	Medicare Advantage	CA	prior auth required		Jul 1, 2021	Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021
Molina Healthcare of California	Medicaid	CA	prior auth required		Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of Florida	Medicare Advantage	FL	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021
Molina Healthcare of Idaho	Medicaid	ID	prior auth required		Jan 1, 2025	Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of Idaho	Medicare Advantage	ID	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021
Molina Healthcare of Illinois	Medicaid	IL	prior auth required		Jan 1, 2022	Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of Iowa	Medicaid	IA	prior auth required		Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of Michigan	Medicare Advantage	MI	prior auth required		Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Michigan	Medicaid	MI	prior auth required		Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Michigan	Exchange	MI	prior auth required		Jul 1, 2021	Molina Healthcare of Michigan PA Matrix, effective 7/1/2021
Molina Healthcare of Mississippi	Medicaid	MS	prior auth required		Jan 1, 2025	Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of Nevada	Medicaid	NV	prior auth required		Oct 1, 2022	Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022
Molina Healthcare of New Mexico	Medicare Advantage	NM	prior auth required		Jan 1, 2021	Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021
Molina Healthcare of New Mexico	Medicaid	NM	prior auth required	Molina follows New Mexico Senate Bill 39 and waives PA where applicable	Jul 1, 2026	New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
Molina Healthcare of Ohio	Medicaid and MyCare Ohio (MMP) Medicaid	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Medicare and MyCare Ohio (MMP) Medicare	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Exchange	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of South Carolina	Medicare Advantage	SC	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021
Molina Healthcare of Texas	Outpatient drug services (medical benefit)	TX	prior auth required		Aug 1, 2026	Medicaid Prior Authorization (PA) Code Matrix for Outpatient Drug Services (Texas), 2026-08
Molina Healthcare of Texas	STAR	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of Texas	STAR+PLUS	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of Texas	Exchange	TX	prior auth required		Sep 1, 2019	Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Molina Healthcare of Utah	Medicaid	UT	prior auth required		Jan 1, 2025	Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Molina Healthcare of Utah	Medicare Advantage	UT	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021
Molina Healthcare of Washington	Medicare Advantage	WA	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021
Molina Healthcare of Wisconsin	Medicare Advantage	WI	prior auth required		Oct 1, 2021	Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021
Molina Healthcare, Inc. (national grid)	Molina national (MHI) Medicare grid	All	prior auth required		Oct 1, 2021	Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth required		Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+	CO	prior auth required		Oct 1, 2026	Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans Prime / RAE	CO	prior auth required		Oct 1, 2026	Rocky Mountain Health Plans PRIME Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Medicare Advantage D-SNP	CO	prior auth required		Feb 1, 2025	Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
UnitedHealthcare	Preferred Care Network and Preferred Care Partners of Florida	FL	prior auth required		Oct 1, 2026	Prior authorization requirements for Preferred Care Network and Preferred Care Partners of Florida Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP)	All	prior auth required	Excluded plans: for therapeutic radiopharmaceuticals: UHC Nursing Home Plan and UHC Care Advantage Plan (I-SNP)	Oct 1, 2026	UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026
UnitedHealthcare Community Plan	AHCCCS Complete Care (ACC)	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Developmentally Disabled	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Long Term Care	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026
UnitedHealthcare Community Plan	Indiana Hoosier Care Connect	IN	prior auth required		Oct 1, 2026	Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026
UnitedHealthcare Community Plan	Indiana PathWays for Aging (MLTSS)	IN	prior auth required		Oct 1, 2026	Prior authorization requirements for Indiana MLTSS Pathways Effective October 1, 2026

Payer coverage policies that name J0585

J0585 appears in 50 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, BlueCross BlueShield of South Carolina, Centene, Cigna, Premera Blue Cross, UnitedHealthcare, Wellmark Blue Cross Blue Shield.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Alopecia Areata (0423)	not covered	Jul 10, 2026	payer document
Aetna	Botulinum Toxin (0113)	covered if criteria are met	Jul 14, 2026	payer document
Aetna	Complex Regional Pain Syndrome (CRPS): Treatments (0447) Ketamine metabolite (2R,6R)-hydroxynorketamine, metformin, topical ketamine, Topical dimethyl sulfoxide, Anakinra, Sarilumab -	not covered	Jul 16, 2026	payer document
Aetna	Diabetic Neuropathy: Selected Treatments (0729) Fulranumab, Ozone Therapy, Ghrelin, Interleukin - 6, mecobalamin (a vitamin B12 analog), pulsed magnetic field treatment	not covered	Feb 24, 2026	payer document
Aetna	Dry Eyes (0457)	not covered	Jul 29, 2026	payer document
Aetna	Erectile Dysfunction and Peyronie's Disease (0007)	not covered	Jul 29, 2026	payer document
Aetna	Facial Nerve Paralysis (0745) Kinesio taping	not covered	Oct 30, 2025	payer document
Aetna	Headaches: Invasive Procedures (0707)	not covered	Jul 23, 2026	payer document
Aetna	Headaches: Nonsurgical Management (0462) Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (e.g., eptinezumab, erenumab, fremanezumab, and galcanezumab), ketamine infusion combined with magnesium, Sodium oxybate	not covered	Jul 23, 2026	payer document
Aetna	Hyperhidrosis (0504)	covered if criteria are met	Aug 11, 2026	payer document
Aetna	Hypertrophic Scars and Keloids (0389) Dermal substitutes, Losartan ointment, Topical oxandrolone	not covered	May 28, 2026	payer document
Aetna	Injectable Medications (0020)	listed, no stance (range J0278-J2543)	Mar 5, 2026	payer document
Aetna	Knee Arthroscopy / Osteoarthritis of the Knee (0673)	not covered	Feb 19, 2026	payer document
Aetna	Levator Syndrome Treatments (0679)	not covered	Oct 15, 2025	payer document
Aetna	Mechanical Stretching Devices for Contracture and Joint Stiffness (0405)	listed, no stance	Jun 30, 2026	payer document
Aetna	Obesity Surgery (0157)	not covered	Jul 21, 2026	payer document
Aetna	Paralytic Lagophthalmos Treatments (0366)	not covered	May 22, 2026	payer document
Aetna	Plantar Fasciitis Treatments (0235) Kinesio Tex taping, local ozone (O2-O3) injection, TenJet system, Hyaluronic acid	not covered	Apr 27, 2026	payer document
Aetna	Post-Herpetic Neuralgia (0725)	not covered	Oct 20, 2025	payer document
Aetna	Selective Peripheral Denervation (Bertrand Procedure) (0401)	listed, no stance	Jul 6, 2026	payer document
Aetna	Spasticity Management (0362)	not covered	May 26, 2026	payer document
Aetna	Temporomandibular Disorders (0028)	not covered	Mar 12, 2026	payer document
Aetna	Thoracoscopic Sympathectomy (0310)	listed, no stance	May 20, 2026	payer document
Aetna	Tourette's Syndrome (0480) Ecopipam, pramipexole, VMAT-2 inhibitors (e.g., valbenazine), amphetamines, Deutetrabenazine (Austedo)	not covered	Jul 24, 2026	payer document
Aetna	Trigeminal Neuralgia: Treatments (0374) Topical ambroxol, Erenumab, Intravenous ketamine	not covered	Jun 29, 2026	payer document
Aetna	Ultrasound Guidance – Selected Indications (0952)	not covered	Apr 27, 2026	payer document
Aetna	Vocal Cord Paralysis / Insufficiency Treatments (0253)	not covered	Apr 15, 2026	payer document
Aetna	Vulvodynia and Vulvar Vestibulitis Treatments (0759)	not covered	Nov 12, 2025	payer document
Blue Cross & Blue Shield of Mississippi	Botulinum Toxin (L.5.01.491)	not covered		payer document
Blue Cross & Blue Shield of Mississippi	Botulinum Toxin (S.5.01.491)	not covered		payer document
Blue Cross Blue Shield of Massachusetts	Botulinum Toxin Injections (006)	listed, no stance		payer document
BlueCross BlueShield of South Carolina	Botulinum Toxin (CAM 50105) 788.30-788.39 \| Urinary incontinence code range	listed, no stance	Nov 1, 2025	payer document
BlueCross BlueShield of South Carolina	Treatment of Hyperhidrosis (CAM 80119) 97033 \| Application of a modality to 1 or more areas; iontophoresis, each 15 minutes	listed, no stance	Jun 1, 2025	payer document
Centene	OnabotulinumtoxinA (Botox) (CP.PHAR.232)	covered if criteria are met	May 1, 2026	payer document
Cigna	Botulinum Toxins – Botox (IP0637)	covered if criteria are met	May 15, 2026	payer document
Cigna	Scar Revision (0328)	not covered	Jun 15, 2026	payer document
Premera Blue Cross	Botulinum Toxin (5.01.512)	listed, no stance	Sep 8, 2026	payer document
Premera Blue Cross	Cosmetic and Reconstructive Services	listed, no stance	Apr 1, 2026	payer document
Premera Blue Cross	Temporomandibular Joint Disorder (2.01.535)	listed, no stance	Apr 13, 2026	payer document
UnitedHealthcare	Botulinum Toxins A and B (CS2026D0017AQ)	listed, no stance	Apr 1, 2026	payer document
UnitedHealthcare	Botulinum Toxins A and B (2026D0017AN)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Botulinum Toxins A and B (for Indiana Only) (CSIND0017.08)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Botulinum Toxins A and B (for Ohio Only) (CSOH2026D0017.E)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Maximum Dosage and Frequency (2026D0034AU)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Maximum Dosage and Frequency (CS2026D0034AV)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Maximum Dosage and Frequency (for Ohio Only) (CSOH2026D0034.K)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Maximum Dosage and Frequency (for Pennsylvania Only) (CSPA2026D0034AS)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Medicare Part B Step Therapy Programs (IAP.001.30) Preferred	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Treatment of Temporomandibular Joint (TMJ) (MMP025.14) Botulinum Toxins A and B	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Neuromuscular Blocking Agents (05.01.02)	listed, no stance	Jun 1, 2026	payer document

Recent prior-auth changes

Jan 1, 2027: PA removed, CarePlus Health Plans
Jan 1, 2027: PA removed, Humana
Jan 1, 2027: PA removed, Humana
Jan 1, 2027: PA removed, Humana
Jan 1, 2026: conditions changed, Blue Cross and Blue Shield of Illinois
Jan 1, 2026: PA removed, Humana
Nov 1, 2025: PA added, UnitedHealthcare Community Plan
Nov 1, 2025: PA added, UnitedHealthcare Community Plan
Nov 1, 2025: PA added, UnitedHealthcare Community Plan
Apr 1, 2025: PA removed, UnitedHealthcare

Medicaid fee-for-service

Prior authorization required or conditional in CO, MS, NE, VA, VT, WA, WV, WY.

AZ: $6.18 (asc), effective Oct 1, 2026
FL: $600.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $6.34 (practitioner), effective Apr 1, 2026
IN: $5.81 (professional, Advanced Practice Nurse (85%), non-facility), effective Oct 1, 2025
KS: $6.51 (default), effective Jan 1, 2026
KY: $6.51 (asc), effective Jan 1, 2026
MS: $5.20 (comprehensive, facility), effective Oct 1, 2025
NE: $6.50 (injectables), effective Jul 1, 2026
OH: $6.50 (provider_administered_drugs), effective Jan 1, 2026
OK: $6.51 (physician, non-facility), effective Jul 1, 2026
TX: $6.51 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
VA: $6.50 (medical), effective Jul 1, 2026
VT: $4.94 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $6.51 (professional_administered_drugs), effective Jul 1, 2026
WY: $2.82 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J0585 Injection,onabotulinumtoxina