Medicare local coverage
Medicare coverage for Botulinum Toxin Type A & Type B (LCD)
One Medicare Administrative Contractor, WPS Insurance Corporation, publishes a local coverage determination (LCD) for Botulinum Toxin Type A & Type B. The snapshot lists 1 LCD record: 1 retired.
An LCD applies only in the jurisdiction of the contractor that wrote it. Two contractors can cover the same service with different criteria, documentation requirements and covered diagnoses, so check the LCD from the contractor that processes your claims.
LCDs by contractor
| Contractor | LCD | Status | Last updated |
|---|---|---|---|
WPS Insurance CorporationMAC - Part A, MAC - Part B | L34635 | Retired Feb 21, 2026 | Feb 21, 2026 |
An LCD marked Future has been finalized and is in its notice period; it applies from the effective date shown. LCD IDs link to the record on cms.gov.
Billing and coding articles
The codes live in the billing and coding article that goes with each LCD: the CPT and HCPCS codes the policy applies to, the ICD-10 codes that support medical necessity, and any modifier or documentation rules.
- A57474WPS Insurance CorporationUpdated Feb 21, 2026
Check claim lines against Medicare coverage
Coverage Check tells you whether a claim's diagnoses support Medicare LCD or NCD coverage for each procedure line, and shows the policy and CMS source behind each answer.
Related LCD topics
- Botulinum Toxin Injections
- B-Type Natriuretic Peptide (BNP)
- B-type Natriuretic Peptide (BNP) Testing
- Botulinum Toxins
- Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus
- RAST Type Tests
All Medicare LCD topics · National coverage determinations · Payer policies by payer
Source: CMS Medicare Coverage Database, via the public CMS Coverage API, snapshot Oct 25, 2026. LCDs change between snapshots; confirm the version in effect for your date of service on cms.gov before billing.