Spasticity - Reimbursement Advocacy

Quality & Practice

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AAPM&R celebrates the advocacy efforts of several Academy members who worked throughout 2024 and 2025 to secure significant wins for patient access to botulinum toxin. In May and November of 2024, Medicare Administrative Contractors (MACs) released two waves of draft botulinum toxin injection coverage policies. If implemented as drafted, these policies could have restricted toxin coverage for patients with spasticity secondary to paralysis. Some policies may have also limited ultrasound guidance for spasticity injections and include dosing limitations below clinically accepted standards. To prevent these policies from being implemented as written, the Academy and our member advocates activated to respond to these drafts and met directly with MAC leaders when written comments were insufficient.

AAPM&R thanks John Baratta, MD, MBA, FAAPMR; Zachary Bohart, MD, MS, FAAPMR; Ryan Hafner, MD, FAAPMR; Kimberly Heckert, MD, FAAPMR; Christina Kwasnica, MD, FAAPMR; Mary Beth Russell, DO, MS, FAAPMR; and Lauren Shapiro, MD, MPH, FAAPMR for their work to preserve patient access to botulinum toxin!

CGS, NGS, Noridian, WPS, and Palmetto

AAPM&R began engaging with MAC leadership over the summer of 2024 to address concerns with the draft LCD published by CGS, NGS, Noridian, WPS, and Palmetto in May 2024. Academy members John Baratta, MD, MBA, FAAPMR; Zachary Bohart, MD, MS, FAAPMR; Kimberly Heckert, MD, FAAPMR; Christina Kwasnica, MD, FAAPMR; and Lauren Shapiro, MD, MPH, FAAPMR assisted with drafting comment letters and eventually began dialogues directly with physician leadership at the MACs to discuss recommendations for policy revisions. The MACs finalized their policies in early 2026, and the academy was pleased to see that they largely align with the requests the Academy made in our comments to and advocacy discussions with the MACs. These finalized policies are the product of strong advocacy from our member leaders who worked to ensure their patients would have appropriate access to spasticity care.

First Coast Service Options and Novitas Solutions

In November 2025, Academy members Ryan Hafner, MD, FAAPMR; Kimberly Heckert, MD, FAAPMR; and Mary Beth Russell, DO, MS, FAAPMR; and Lauren Shapiro, MD, MPH, FAAPMR met with First Coast Service Options and Novitas Solutions medical directors to discuss the list of ICD-10 diagnosis codes finalized in the Billing and Coding Article: Botulinum Toxins and expressed concern about access for patients with spasticity secondary to paralysis resulting from stroke, spinal cord injury, etc. At the conclusion of our collaborative discussion with Novitas and First Coast, a solution to address the potential coding gap for these patients was identified. In December, Novitas and First Coast published an updated Billing and Coding Article offering coding clarity and directing that physicians should bill code M62.838 for other muscle spasm in combination with an appropriate paralysis code (paraplegia, quadriplegia, monoplegia) to capture spasticity secondary to paralysis.

Staying Engaged

Spasticity remains an ongoing priority for AAPM&R in many areas. We invite members to join the conversation in the Spasticity Community on PhyzForum. Additionally, we encourage members to watch for upcoming information about spasticity-related Expert Conversations in PM&R Practice.