Medicare fee-for-service
Billing and Coding
Grasp the changing landscape of Medicare with the information you need to know.
2026 Physician Fee Schedule
- 2026 Medicare Physician Fee Schedule Payment, Policy, and Reimbursement Updates | Webinar recorded December 10, 2025
- AAN President, Natalia S. Rost, MD, MPH, FAAN, FAHA, addresses practice sustainability and reimbursement challenges for neurologists
- The AAN’s summary of the 2026 Medicare Physician Fee Schedule Final Rule
- The AAN’s summary of the 2026 Medicare Physician Fee Schedule Proposed Rule
- The AAN's comment letter on the 2026 Proposed Fee Schedule
WISeR Model (effective January 1, 2026)
Medicare Coverage Determinations
Botulinum toxin injections
Five Medicare Administrative Contractors (MAC) recently implemented new policies for the provision of botulinum toxin injections for services performed on or after February 22, 2026. The new local coverage determinations (LCD) from CGS, NGS, Noridian, WPS, and Palmetto GBA include dosing guidelines and new documentation requirements, including the administration of an objective assessment to measure illness severity at baseline, after each diagnostic procedure, and at each follow-up assessment for the treatment of conditions such as migraine, dystonia, blepharospasm, and sialorrhea, among others.
MACs may create LCDs that apply to their geographic jurisdictions to explain when a service or procedure is considered reasonable and medically necessary. LCDs outline coverage criteria, medical necessity standards, and coding and billing rules. AAN members should verify coverage requirements for their individual MAC and other commercial payers, as policies may vary.
Practices that administer botulinum toxin injections and contract with these MACs should be aware of greater off-label justification requirements, allowed baseline and subsequent dosing, and whether documentation practices correspond to the indications of coverage for each condition.
Additionally, many providers may not routinely administer objective clinical scales for each of the conditions outlined in the policy. The LCD suggests a series of scales for each diagnosis, but practices should consider options that work best for their clinical workflows.
The current policies and related coding articles for each MAC are included below. Questions? Email practice@aan.com.
CGS
NGS
Noridian
WPS
Palmetto GBA
Medicare Administrative Contractor (MAC)
Top 5: Things to Know about Working with Medicare Administrative Contractors (MAC)
Evaluation and Management
Read the latest Evaluation and Management (E/M) news and stay current on E/M coding and documentation guidelines.