Botulinum Toxin. Number 0.Policy. Onabotulinumtoxin.DIRETRIZES. IV Diretriz da Sociedade Brasileira de Cardiologia sobre Tratamento do Infarto Agudo do Miocrdio com Supradesnvel do Segmento ST.A Botox Brand of Botulinum Toxin Type A Aetna considers onabotulinumtoxin.A Botox medically necessary for any of the following conditions Esotropia, horizontal strabismus with deviations of less than 5.Talley And O Connor Clinical Examination 6Th Edition Pdf' title='Talley And O Connor Clinical Examination 6Th Edition Pdf' />The rectum from the Latin rectum intestinum, meaning straight intestine is the final straight portion of the large intestine in humans and some other mammals, and.Issuu is a digital publishing platform that makes it simple to publish magazines, catalogs, newspapers, books, and more online.Easily share your publications and get.OnabotulinumtoxinA Botox Brand of Botulinum Toxin Type A Aetna considers onabotulinumtoxinA Botox medically necessary for any of the following conditions.VI palsies of 1 month duration or longer including gaze palsies accompanying diseases, such as neuromyelitis optica and Schilders disease, as an alternative to surgery, or previous failed surgery, when interference with normal visual system development is likely to occur and when spontaneous recovery is unlikely.Note Strabismus repair is considered cosmetic in adults with uncorrected congenital strabismus and no binocular fusion.Blepharospasm, characterized by intermittent or sustained closure of the eyelids caused by involuntary contractions of the orbicularis oculi muscle, including blepharospasm associated with dystonia and benign essential blepharospasm.Post facial 7th cranial nerve palsy synkinesis hemifacial spasms, characterized by sudden, unilateral, synchronous contractions of muscles innervated by the facial nerve.Laryngeal spasm. Cervical dystonia spasmodic torticollis of moderate or greater severity when all of the following criteria are met There are clonic andor tonic involuntary contractions of multiple neck muscles e.There is sustained head torsion andor tilt with limited range of motion in the neck and.The duration of the condition is greater than 6 months and.Alternative causes of the members symptoms have been considered and ruled out, including chronic neuroleptic treatment, contractures, or other neuromuscular disorders.Focal hand dystonias i.Documentation that abnormal muscle tone is causing persistent pain andor interfering with functional ability, and.Documented failure on conservative medical therapy.Focal dystonias, including Adductor laryngeal dystonia Focal dystonias in corticobasilar degeneration Jaw closing oromandibular dystonia, characterized by dystonic movements involving the jaw, tongue, and lower facial muscles Lingual dystonia Symptomatic torsion dystonia but not lumbar torsion dystonia.Limb spasticity, including Equinus varus deformity or other lower limb spasticity in children with cerebral palsy in the absence of significantly fixed deformity Hereditary spastic paraplegia Limb spasticity due to multiple sclerosis Limb spasticity due to other demyelinating diseases of the central nervous system including adductor spasticity and pain control in children undergoing adductor lengthening surgery as well as children with upper extremity spasticity Spastic hemiplegia, such as due to stroke or brain injury.When the following criteria are met Documentation that abnormal muscle tone is either interfering with functional ability, or is expected to result in joint contracture with future growth, and.Documented failure to standard medical treatments, and.Surgical intervention is considered to be the last option, and.Treatment is being requested to enhance function or allow additional therapeutic modalities to be employed.Esophageal achalasia, for individuals who have any of the following Are at high risk of complications of pneumatic dilation or surgical myotomy or.Advanced age or limited life expectancy or.Have failed conventional therapy or.Have failed a prior myotomy or dilation or.Have had a previous dilation induced perforation or.Have a sigmoid shaped esophagus or.Have an epiphrenic diverticulum or hiatal hernia, both of which increase the risk of dilation induced perforation.Chronic greater than 2 months anal fissure unresponsive to conservative therapeutic measures e.Intractable, disabling focal primary hyperhydrosis axillae, palms, and soles, when all of the following are met Member is unresponsive or unable to tolerate pharmacotherapy prescribed for excessive sweating e.Significant disruption of professional andor social life has occurred because of excessive sweating and.Topical aluminum chloride or other extra strength antiperspirants are ineffective or result in a severe rash.Ptyalismsialorrhea excessive secretion of saliva, drooling that meets both of the following criteria Refractory to pharmacotherapy including anticholinergics and Documentation of medically significant complications of sialorrhea, such as chronic skin maceration or infections that cannot be controlled with topical treatments or hygiene.Facial myokymia and trismus associated with post radiation myokymia.Hirschsprungs disease with internal sphincter achalasia following endorectal pull through.Medically refractory upper extremity tremor that interferes with activities of daily living ADLs.Additional botulinum toxin injections are considered medically necessary if response to a trial of botulinum toxin enables ADLs or communication.Neurogenic detrusor bladder overactivity or detrusor sphincter dyssynergia resulting from a spinal cord injury, multiple sclerosis or other neurologic condition when the following criteria are met Documentation of detrusor overactivity or dyssynergia confirmed by urodynamic testing, and.Documented failure of behavioral therapy, and.Documented failureintolerance to at least one adequately titrated anticholinergic medication e.Overactive bladder OAB with symptoms of urge urinary incontinence, urgency, and frequency, in adults who meet the following criteria Documented failure of behavioral therapy, and.Documented failureintolerance to at least three adequately titrated prescription overactive bladder medications e.Ditropan, trospium Sanctura, tolterodine Detrol, darifenacin Enablex, fesoterodine Toviaz, mirabegron Myrbetriq, solifenacin Vesicare, duloxetine Cymbalta or two adequately titrated prescription overactive bladder medications and an OTC bladder medication oxybutynin transdermal patch Oxytrol for Women.Onabotulinumtoxin.A when used in the treatment of urinary incontinence is contraindicated and considered experimental and investigational for the following In persons with acute urinary tract infections andor acute urinary retention Members that have not received prophylactic antibiotics except aminoglycosides which should be administered 1 3 days pre treatment, on the treatment day, and 1 3 days post treatmentWhen onabotulinumtoxin.A is given in combination with other anticholinergic agents.Freys syndrome gustatory sweating.Orofacial tardive dyskinesia when conventional therapies had been tried and failed e.Migraines for prevention of chronic more than 1.Angiotensin converting enzyme inhibitorsangiotensin II receptor blockers e.Anti depressants e.Anti epileptic drugs e.Beta blockers e. Calcium channel blockers e.Botulinum toxin is considered experimental and investigational for migraines that do not meet the above listed criteria.Note If members do not respond to a course of treatment usually lasts for 1.Note Continuing treatment with botulinum toxin injection for ongoing prevention of chronic migraine headaches is considered medically necessary when Migraine headache frequency was reduced by at least 7 days per month when compared to pre treatment average by the end of the initial trial or.Migraine headache duration was reduced by at least 1.Painful bruxism. Palatal myoclonus with disabling symptoms e.Individuals with persistent symptoms of first bite syndrome and who have failed analgesics, antidepressants, and gabapentin.Rimabotulinumtoxin.B Myobloc Brand of Botulinum Toxin Type B Aetna considers rimabotuninumtoxin.B Myobloc medically necessary for the treatment of any of the following conditions Individuals with cervical dystonia spasmodic torticollis of moderate or greater severity when the following criteria are met Alternative causes of the members symptoms have been considered and ruled out, including chronic neuroleptic treatment, contractures or other neuromuscular disorders and.There is sustained head torsion andor tilt with limited range of motion in the neck and.The duration of the condition is greater than 6 months and. Crackle The Best Of Bauhaus Download Games more. There are clonic andor tonic involuntary contractions of multiple neck muscles e.Ptyalismsialorrhea excessive secretion of saliva, drooling that meets the following criteria Refractory to pharmacotherapy including anticholinergics and.
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