G869 – Botulinum toxin injection(s) of bladder detrusor muscle

Botulinum toxin injection(s) of the bladder detrusor muscle. Payment for this service is subject to specific conditions and limitations. Payment Rules: 1. G869 is only eligible for payment for the management of symptomatic refractory overactive bladder that has not responded to a minimum of three months of active treatment with behavioral modification or anticholinergics. 2. Only one G869 service is eligible for payment per patient per day and includes all injections necessary to deliver the total dosage (one treatment) that is recommended in current practice guidelines. 3. G869 is only eligible for payment for one treatment per patient every 12 weeks. If, in the opinion of the treating physician, more frequent treatments are necessary, the claim must be submitted for manual review with supporting documentation. Authorization will be dependent on the physician demonstrating that the increased frequency of the service is generally accepted as necessary for the patient under the circumstances.