CPT 64615: Botulinum Toxin Injections for Chronic Migraine
64615 reports the set of injections that place botulinum toxin into head and neck muscles to prevent chronic migraine. It is one code for the whole session with both sides included, and the drug is billed separately on its own HCPCS J line with the units given.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 64615 bills one chronic migraine injection session with no modifier 50, because the fee schedule prices it as bilateral. It has a 010-day global, the toxin goes on a J line with JW or JZ, and a Medicare LCD sets the migraine day counts and the 12-week limit.
What Does CPT 64615 Report?
64615 reports the injection of botulinum toxin into head and neck muscles to prevent chronic migraine. CMS labels it "Chemodenerv musc migraine" in the October 2026 fee schedule file, and the file prices it as a bilateral service, so one unit covers both sides of the head and neck.
| Item in RVU26D and the MUE tables | 64615 |
|---|---|
| Payment status | A |
| Work RVU | 1.80 |
| Total RVU, non-facility | 4.70 |
| Total RVU, facility | 3.27 |
| PC/TC indicator | 0 (26 and TC do not apply) |
| Global period | 010 |
| Bilateral surgery indicator | 2 |
| Practitioner MUE, effective 10-01-2026 | 1 (indicator 2) |
| J0585 MUE, practitioner and hospital outpatient | 800 units (indicator 3) |
Does 64615 Take Modifier 50?
No. The RVU file's bilateral indicator for 64615 is 2, which CMS defines as RVUs already based on a bilateral procedure with no 150 percent adjustment. Billing and Coding Article A59707 says to report only one unit of 64615 and not to use modifier 50.
The same article says the opposite for 64612 and 64616, whose indicator is 1: they take modifier 50 when done on both sides.
How Is the Botox Billed with 64615?
The drug goes on its own line with a J code and the number of units given. The October 2026 HCPCS file lists J0585 for onabotulinumtoxinA per 1 unit, J0586 for abobotulinumtoxinA per 5 units, J0587 for rimabotulinumtoxinB per 100 units, J0588 for incobotulinumtoxinA per 1 unit and J0589 for daxibotulinumtoxinA-lanm per 1 unit. Article A59707 says onabotulinumtoxinA comes in 100-unit vials and is billed per unit.
Medicare asks for modifier JW on a separate line for wasted drug from a single-dose vial and, since July 1, 2023, modifier JZ when none was discarded.
A patient gets the LCD's initial dose of 155 units, drawn from two 100-unit vials. The claim has 64615 once, J0585 with 155 units, and J0585-JW with 45 units on a second line. The J0585 total of 200 units sits well under the MUE of 800.
When J0585 is denied, the same article says the related injection code is subject to denial too, so a drug error can sink the 64615 line.
What Does Medicare Require for Chronic Migraine?
The rules below come from the Wellpoint Federal LCD L39832 (formerly National Government Services), effective February 22, 2026. Other contractors may differ, so confirm yours. For initial injections the LCD asks for all of these:
- 15 or more headache days a month and 8 or more migraine days a month, each migraine day lasting 4 hours or more, for at least 3 months
- A two-month trial with inadequate response, or a contraindication, for one agent in each of two of four drug classes: antidepressant, beta blocker, calcium channel blocker or antiepileptic
- Objective, documented functional disability, and a toxin serotype approved by the FDA for chronic migraine prophylaxis
The LCD sets the onabotulinumtoxinA dose at 155 to 195 units, with the first treatment at 155 units, given as 5 units per site across 7 head and neck muscles. Later injections need at least a 50 percent drop in migraine days and in headache episodes a month. Injections cannot be given more often than every 12 weeks, and doses above 195 units are not covered.
The LCD does not cover botulinum toxin for episodic migraine, tension-type headache or chronic daily headache, and says it is not reasonable to give other procedures such as epidural injections, sympathetic blocks or trigger point injections on the same day. See LCDs and NCDs for how local policy works.
Can You Bill a Visit with 64615?
Yes, if the visit is significant and separately identifiable, with modifier 25 on the visit. 64615 has a 010 global, so NCCI Chapter I calls it a minor procedure: the decision to inject is included in the payment. Chapter 12 of the Claims Processing Manual adds that follow-up care within 10 days that relates to recovery is not paid separately. See global surgery periods and neurology billing.
How Does 64615 Appear on the Claim?
On the CMS-1500, Item 24D carries 64615 and then each J line, Item 24G carries 1 unit for 64615 and the drug units for J lines, and Item 24E points each line to the chronic migraine diagnosis. Place of service is 11 for an office and 22 or 19 for hospital outpatient.
What Belongs on the Claim Line for Migraine Injections?
The migraine injection is one line, 64615 in Item 24D with 1 unit in Item 24G and a pointer in Item 24E to the migraine diagnosis. The drug is billed on its own line with its own code and units. The pattern of injection sites belongs in the note.
RVU26D gives 64615 status A, a 010 global and a bilateral indicator of 2, meaning the RVUs already assume both sides. The MUE table allows 1 per date with indicator 2.
Example: A patient with chronic migraine gets the series on 10/11. Line 1 is 64615, pointer A (G43.709), 1 unit, $360.00. Line 2 is the drug code with the units given. Adding LT and RT to 64615 may draw CO-4 since the RVUs are already bilateral.
Why Is 64615 Denied?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 50 | Non-covered services because this is not deemed a 'medical necessity' by the payer | Chart lacks migraine day counts or the two failed drug classes |
| 167 | This (these) diagnosis(es) is (are) not covered | Episodic migraine or tension headache coded |
| 151 | Payment adjusted because the payer deems the information submitted does not support this many/frequency of services | A second session before 12 weeks |
| 4 | The procedure code is inconsistent with the modifier used | Modifier 50 added to 64615 |
If these denials keep coming back, our denial management team can work them. See also CPT 95910 and Medicare payer rules.
Related Codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner and outpatient hospital tables, effective 10-01-2026 · CMS
- HCPCS Level II quarterly update, October 2026 alpha-numeric file · CMS
- LCD L39832, Botulinum Toxin Injections (Wellpoint Federal) · CMS Medicare Coverage Database
- Billing and Coding Article A59707, Botulinum Toxin Injections · CMS Medicare Coverage Database
- 2026 NCCI Medicare Policy Manual, Chapter I: General Correct Coding Policies · CMS
- Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners · CMS
- Claim Adjustment Reason Codes · X12
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Place of service code set · CMS
We check every rule, code and deadline against the official source. See our editorial policy.
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What does CPT 64615 mean?
It reports injections of botulinum toxin into head and neck muscles to prevent chronic migraine. CMS labels it "Chemodenerv musc migraine". It has a 010-day global period and is priced as a bilateral service, so a session is billed with one unit and no modifier 50.
02How do I bill botulinum toxin for migraine?
Bill 64615 once, then the toxin on its own J line, such as J0585 with the units given, and wasted drug on a JW line. Use JZ if none was discarded. Point every line to the chronic migraine diagnosis and keep the dose, sites and migraine day counts in the note.
03How often can chronic migraine botulinum toxin be given?
The Wellpoint Federal LCD says botulinum toxin must not be given more often than every 12 weeks. Repeat treatment also needs at least a 50 percent reduction in migraine days and in headache episodes a month, plus improved function, documented against the baseline scale.
04How many units of J0585 can I bill?
The October 2026 MUE is 800 units for both practitioner and outpatient hospital claims, with indicator 3. The LCD's own dose range is 155 to 195 units, with doses above 195 units not covered, so the MUE is a ceiling and not a target.
05Which diagnoses support 64615?
Article A59707 lists a separate group of ICD-10-CM chronic migraine codes in the G43 range for 64615 and J0585. Episodic migraine, tension-type headache and chronic daily headache are listed as not medically necessary in the LCD, so those diagnoses are likely to deny under CARC 167 or 50.
Botox Claims Denied?
We check the migraine day counts, the drug units and the JW line before the claim goes out.