CPT for ENT: Chemodenervation of the Larynx – Botulinum Toxin

Q: What is the Academy’s recommendation for billing Botulinum toxin A injections of the larynx?

A: Botulinum toxin – A is most commonly administered in the larynx by percutaneous injection using laryngeal electromyography (LEMG) for guidance. The American Medical Association’s Correct Procedural Terminology (CPT®) 2017 changed the coding for laryngeal chemodenervation:

• CPT code 31573-Laryngoscopy, flexible, diagnostic with therapeutic injection (s) (e.g., chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral.  This code does not include use of EMG for localization.
• Add CPT code + 95874-Needle electromyography for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure). Add modifier 26 (Professional Component) to +95874 if you do not own the EMG equipment.
• J0585 Botulinum toxin type – A, per unit (report the number of units injected)
• If Botulinum toxin A is injected by direct laryngoscopy, use CPT codes 31570- Laryngoscopy, direct with injection into the vocal cord (s), therapeutic, or 31571-Laryngoscopy, direct, with injection into the vocal cord (s) therapeutic; with operating microscope or telescope.

Reimbursement Issues: Botulinum toxin – A Injections of the Larynx

• Payers should reimburse both chemodenervation and EMG for localization when performed together. Good documentation helps!
• Check your local Medicare carrier’s Local Coverage Determination (LCD)
• Medicare will reimburse for unused (“waste”) Botulinum toxin A, if the remainder of the vial is discarded. Remember to report the number of units in the box. For more details, https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57185

Reviewed October 2023

IMPORTANT DISCLAIMER NOTICE

CPT FOR ENT ARTICLES ARE A COLLABORATIVE EFFORT BETWEEN THE ACADEMY’S TEAM OF CPT ADVISORS, MEMBERS OF THE PHYSICIAN PAYMENT POLICY (3P) WORKGROUP, AND HEALTH POLICY STAFF. ARTICLES ARE DEVELOPED TO ADDRESS COMMON CODING QUESTIONS RECEIVED BY THE HEALTH POLICY TEAM, AS WELL AS TO CLARIFY CODING CHANGES AND CORRECT CODING PRINCIPLES FOR FREQUENTLY REPORTED ENT PROCEDURES. THESE ARTICLES ARE NOT INTENDED AS LEGAL, MEDICAL, OR BUSINESS ADVICE AND ARE NOT A GUARANTEE OF REIMBURSEMENT. THE INFORMATION IS ALSO NOT MEANT TO SERVE AS THE DEFINITIVE OR SOLE AUTHORITY ON BILLING AND CODING ISSUES. THE APPLICABILITY OF AAO-HNS BILLING AND CODING GUIDANCE FOR A PARTICULAR PROCEDURE, MUST BE DETERMINED BY THE RESPONSIBLE PHYSICIAN IN LIGHT OF ALL THE CIRCUMSTANCES PRESENTED BY THE INDIVIDUAL PATIENT. YOU SHOULD CONSULT WITH YOUR OWN ADVISORS AS WELL AS MEDICARE OR PRIVATE CARRIERS IN MAKING ANY DECISIONS ABOUT HOW TO BILL AND CODE PARTICULAR SERVICES OR PROCEDURES.