On Monday October 20, AAPM&R submitted a letter to Novitas Solutions and First Coast Service Options regarding their new local coverage determination (LCD) for botulinum toxin, L33274 (First Coast) or L38809 (Novitas), and associated billing and coding article A57715 (First Coast) or A58423 (Novitas), slated for implementation on November 9. The new LCDs remove numerous ICD-10-CM codes which have long supported medical necessity for botulinum toxin injections to treat spasticity. Because this policy reflects a significant change to coverage, AAPM&R has requested immediate clarification of covered diagnoses under First Coast and Novitas policy. Further, we have recommended a delay to implementation to allow for clarification. Additionally, we’ve requested reconsideration and the opportunity to meet with the medical directors of both First Coast Service Options and Novitas Solutions to resolve confusion with the goal of finalizing an LCD that allows for appropriate patient care. For more information about our prior advocacy on this effort, members can view our November 2024 comments letters to First Coast and Novitas. Members in jurisdictions overseen by other MACs should be aware that we anticipate final botulinum toxin LCDs for CGS Administrators, National Government Services, Noridian Healthcare Solutions, Palmetto, GBA, and WPS Insurance Company toward the end of 2025 or early 2026. Questions can be directed to healthpolicy@aapmr.org.