Botox and EMG denials by PM&R?

[Doctor Christmas]

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Hey all,
Has anyone come across insurance denying payment for EMGs/Botox for migraines done by PM&R? I was reading a thread on Phyzforum saying some insurances are denying payment for these procedures done by PM&R and only Neuro can do them? How is that possible?

 

[Jitter Bug]

Haven't heard of that, but there are strict criteria for botox being approved for migraines by most insurers (I think you have to fail a few meds first and still have at least 16 migraines per month) so if you don't know the rules it will get denied no matter who you are.

 

[Doctor Christmas]

Haven't heard of that, but there are strict criteria for botox being approved for migraines by most insurers (I think you have to fail a few meds first and still have at least 16 migraines per month) so if you don't know the rules it will get denied no matter who you are.

That's not what I'm referring to though. I'm referring specifically to PM&R trained docs in California having insurance deny payment for Botox administered by PM&R vs. Neuro. Same with EMGs - denial of EMG by PM&R but not neuro trained docs.

 

[Jitter Bug]

Well insurance company approvals vs denials are processed by twenty somethings clicking through computer generated algorithms so anything is possible. I'm in the midwest and this hasn't been an issue.