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.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |