The therapeutic use of Botox (Onabotulinum Toxin A) is quickly becoming recognized as part of the management of facial pain, TMD and muscle hypertrophy. Provinces vary in terms of the scope of the dentist in administering Botox, so make sure to investigate the limitations of your province and keep within your licensing. Here we will present the administrative side of being a Therapeutic Botox provider.

Billing

There are a number of potential codes that can be used for billing under the fee guide. I have found that approximately 20% of my patients are covered, so I set the expectation that it is likely to be out of pocket. The fee that you allocation under the injection code can be adjusted based on your time and the extent of treatment (Often practitioners will aim for $10-12 per unit). The average pricing I have seen is $250-1000 for the injection fee.

78601     Injection, Therpeutic Drug + E
OR
96201     Intramuscular Drug Injection +E

AND
99555     Botox cost (DIN 01981501), $357 per 100 units (2022 pricing on AbbVie)

Ordering

Regarding ordering, there are two options:
1. Clinic orders it from Abbvie/Allergan directly.
2. Clinic writes a prescription for Onabotulinum Toxin A and patient gets it from the pharmacy – may be covered under a drug plan. The botox will cost a little more as there is a dispensing fee. Botox must be stored cold, so I recommend if you do this method to advise the patient to bring a cold container.

Storage

Botox comes as a powder that needs to be reconstituted with saline. Prior to reconstitution, it should be stored in a freezer. After reconstitution it can be stored in a fridge for up to 3 weeks.

Supplies list

  • Botox – ordered via AbbVie
  • Saline – Bacteriostatic Sodium Chloride Injection USP 0.9% 10ml (DIN 00037818), not stored in fridge
  • Insulin Syringe
  • Needle for reconstitution, 18G
  • Needle for injection, 30G
  • Alcohol Wipe for skin
  • Gauze
  • Markers for injection sites

Where to order: pharmacy, medical catalog e.g. Medline