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Welcome  » May 18, 2024 7:24 AM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Physician
05/18/2024  

Prior Authorization : Services Requiring Prior Authorization

Topic #15777

Prior Authorization for Botulinum Toxins to Treat Other Diagnoses

The following must be submitted to request PA for a botulinum toxin for a diagnosis not on the Diagnosis Code-Restricted Physician-Administered Drugs data table:

In addition to the PA request forms, providers are required to submit peer-reviewed medical literature to support the proven efficacy of the botulinum toxin for the specific condition that is to be treated.

Providers may submit PA requests and necessary documentation on the Portal, by fax, or by mail (but not using the STAT-PA system).

 
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