As a reminder, updated Local Coverage Determinations (LCDs) for Botulinum Toxin Injections took effect on Sunday February 22 in five Medicare Administrative Contractor (MAC) jurisdictions. Specifically, members practicing under CGS, NGS, Noridian, WPS, and Palmetto will need to review their new policies in full and comply with them, effective February 22. Under the new LCDs, the MACs require that “an objective assessment must be performed and documented at baseline, after each diagnostic procedure, and at each follow-up assessment.” Required for this assessment is a clinical scale, such as the Ashworth Scale, Modified Ashworth Scale, Tardieu Scale, Modified Tardieu Scales, and the Pendulum Test. Members are encouraged to review the AAPM&R Consensus Guidance on Spasticity Assessment and Management for additional information about the use of clinical scales in the assessment of spasticity. Please note that policies finalized in November for the First Coast and Novitas jurisdictions differ and do not include language regarding required use of a clinical scale. Members with questions about the finalized Botulinum Toxin Injection LCDs can contact healthpolicy@aapmr.org.