Medicare prior authorization · J0589
J0589 — Botulinum Toxin Injection
Subject to CMS’s ASC prior authorization demonstration when furnished in an ambulatory surgical center in CA, FL, TN, PA, MD, GA, NY, TX, AZ, OH. The decision is made on Medicare’s existing coverage policy; nothing in these programs changes what is covered.
The coverage policy the reviewer applies, by contractor
CMS publishes no policy references for this program’s code list. The policies below are the ones whose own procedure-code tables list J0589 — matched by CLV analysis; the linked CMS document is authoritative. Each state’s contractor writes its own, so the policy that decides a request depends on the state.
Novitas · 3 states: MD, PA, TX
- L38809 — Botulinum Toxins — Novitas · CMS version 30 · captured 2026-07-24
Read the documentation requirements in the linked CMS document.
Noridian · 2 states: AZ, CA
- L35170 — Botulinum Toxin Injections — Noridian · CMS version 60 · captured 2026-07-25
- L35172 — Botulinum Toxin Injections — Noridian · CMS version 72 · captured 2026-07-25
This contractor publishes more than one policy listing J0589, and the capture records the contractor rather than the jurisdiction — so which one governs depends on the jurisdiction serving the state. Run the check for your state.
Palmetto GBA · 2 states: GA, TN
- L39836 — Botulinum Toxin Injections — Palmetto GBA · CMS version 8 · captured 2026-07-26
Read the documentation requirements in the linked CMS document.
CGS Administrators · 1 state: OH
- L39857 — Botulinum Toxin Injections — CGS · CMS version 7 · captured 2026-07-26
Read the documentation requirements in the linked CMS document.
First Coast · 1 state: FL
- L33274 — Botulinum Toxins — First Coast · CMS version 43 · captured 2026-07-24
Read the documentation requirements in the linked CMS document.
National Government Services · 1 state: NY
- L33646 — Botulinum Toxins — NGS · CMS version 40 · captured 2026-07-27
- L39832 — Botulinum Toxin Injections — NGS · CMS version 13 · captured 2026-07-25
This contractor publishes more than one policy listing J0589, and the capture records the contractor rather than the jurisdiction — so which one governs depends on the jurisdiction serving the state. Run the check for your state.
ASC prior authorization demonstration
- Where and from when
- ambulatory surgical center only; CA, FL, TN, PA, MD, GA, NY for dates of service on or after 2026-01-19; TX, AZ, OH for dates of service on or after 2026-02-16
- Decision
- 7 calendar days; 2 business days expedited; valid 120 days
- If no request is made
- prior authorization is voluntary; the claim is stopped for prepayment medical record review
- Submit
- the ASC submits to its MAC by mail, fax, esMD (content type 8.7) or the MAC’s portal
- Exemption
- not yet published: “CMS will provide further information regarding exemption.”
Check J0589 for your state, diagnosis and setting
The governing policy as it stands today, whether the diagnosis is on its list, and the documentation the policy’s own text requires — quoted, source-linked, free.
Run the check →Full lists: ASC demonstration code list
Same family: 64612 · 64615 · J0585 · J0586 · J0587 · J0588
Sources: CMS WISeR Provider and Supplier Operational Guide v7.0 (2026-07-24), Appendix A; CMS list of OPD services requiring prior authorization (2024-08-05); CMS list of ambulatory surgical center services for prior authorization (2026-03-05) and the ASC Operational Guide (2026-03-03). Codes are shown as numbers only, as CMS lists them. CPT® is a registered trademark of the American Medical Association.