Billing Tip: Botox injections for chronic migraine sufferers 13.59O

Botox injections for chronic migraine sufferers may now be submitted to the Alberta Health Care Insurance Plan (AHCIP) using HSC 13.59O.

• Botox treatment may be used for chronic migraine sufferers for persons aged 18 to 65 who suffer from migraines more than 15 times a month and have been recommended for this treatment by their physician.
• Follow-up treatment may be claimed in 12 week intervals.
• Only one call may be claimed regardless of the number of injections performed.
• May be claimed in addition to a visit or consultation, when appropriate
• Services for patients under the age of 18 or more than 65 years of age must be billed directly to the patient as this is considered an uninsured service by Alberta Health

Patients may be charged for the Botox following the College of Physicians & Surgeons of Alberta Standards of Practice (Standard 13) Dispensing of Schedule 1 or 2 drugs by a physician for a fee.

The Botox injections for migraines may be claimed in addition to a visit or consultation as appropriate. However, the time spent performing the injections may not be included in the time claimed for complex modifiers or prolonged visits/consultations.

For more information on the management of headaches, please visit the Toward Optimized Practice website.

For more advice from AMA staff on any billing issues, including explanations of recent billing changes, please email AMA billing staff.