CareCost Vials
1 × 200 Units
1 billing unit = 1 Unit
155 Units dose → 155 billing units
J0585 · onabotulinumtoxinA
100 or 200 Unit single-dose vials · JW on most claims, JZ only when the dose exactly fills the vial
Calculate this patient's units ↓155 Units intramuscularly for chronic migraine (PREEMPT protocol), repeated no sooner than every 12 weeks · dose varies by indication, see the table below
This Botox claim carries straight into Claim Check.
Claim Check builds the whole visit — J0585 units, the administration line, the modifiers and the Medicare allowed amount — and prices it against your payer's rate. The estimate turns the same visit into what the patient owes.
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Patient owes, 155 Units
Change the payer and the estimate re-prices against that payer's own published rate. The result is a good faith estimate for the patient.
37 payer price files · Commercial + Medicare · Copay and foundation status · Deductible, coinsurance and out-of-pocket math
Botox J0585 is billed in Units: Units administered = billing units, with no conversion factor: 1 billing unit is 1 Unit. Unlike a flat-dose drug, the labeled dose is not the same for every indication: 155 Units for chronic migraine, 100 for overactive bladder, 200 for neurogenic detrusor overactivity, and on through twelve labeled doses, all listed in the table below. Adults never exceed 400 Units total across all indications treated in any 3-month interval.
Botox ships in 100- and 200-Unit single-dose vials, reconstituted with preservative-free saline immediately before use. A dose rarely matches a vial exactly, so the Units drawn and the Units administered are usually two different numbers; the difference is discarded and reported on its own JW line (arithmetic below).
Medicare pays $6.514 per Unit (ASP+6%), effective for claims in Q4 2026 — $1,009.67
for the 155-Unit dose above.
The vial mixer draws the fewest vials that cover the dose, then the least waste among ties. A 155-Unit dose draws one 200-Unit vial and reports 45 Units JW (two 100-Unit vials would leave the same 45, but fewest-vials picks the single 200). 236 Units draws a 200- and a 100-Unit vial (300 drawn) and reports 64 Units JW; 300 Units draws the same two vials with nothing left over, so bill JZ. 150 Units draws one 200-Unit vial and reports 50 Units JW; 100 and 200 Units each draw one vial exactly, so bill JZ. 25 and 5 Units each draw a single 100-Unit vial and report 75 and 95 Units JW; on the strabismus claim the waste line outweighs the drug line.
| Indication | Protocol dose (Units) | Vials drawn | Units on JW | Procedure code |
|---|---|---|---|---|
| Chronic migraine | 155 | 1 × 200 | 45 | 64615 |
| Cervical dystonia | 236 | 1 × 200 + 1 × 100 | 64 | 64616 |
| Overactive bladder | 100 | 1 × 100 | 0 (JZ) | 52287 |
| Neurogenic detrusor overactivity, adult | 200 | 1 × 200 | 0 (JZ) | 52287 |
| Neurogenic detrusor overactivity, pediatric | 200 | 1 × 200 | 0 (JZ) | 52287 |
| Upper limb spasticity, adult | 300 | 1 × 200 + 1 × 100 | 0 (JZ) | 64642 / 64644 |
| Lower limb spasticity, adult | 300 | 1 × 200 + 1 × 100 | 0 (JZ) | 64642 / 64644 |
| Upper limb spasticity, pediatric | 150 | 1 × 200 | 50 | 64642 / 64644 |
| Lower limb spasticity, pediatric | 200 | 1 × 200 | 0 (JZ) | 64642 / 64644 |
| Axillary hyperhidrosis | 100 | 1 × 100 | 0 (JZ) | 64650 |
| Blepharospasm | 25 | 1 × 100 | 75 | 64612 |
| Strabismus | 5 | 1 × 100 | 95 | 67345 |
Protocol doses are the FDA label's representative regimen for each indication (DailyMed 33d066a9, revised 10/2024); cervical dystonia, spasticity and pediatric doses are individualized within the label's range, so an actual claim's Units and JW line can differ from the figures above. 64642 covers 1 to 4 muscles per extremity, 64644 covers 5 or more; the same two codes serve both upper and lower limb spasticity, adult and pediatric.
JZ: no discarded drug from the single-dose vial. JW: discarded drug, reported on its own claim line. One of the two is required on every J0585 claim per CMS's July 1, 2023 single-dose container policy.
J0585 × 155 · J0585 × 45 JW · 64615 × 1 for the bilateral
chemodenervation of the head and neck muscles.
J0585 × 200 JZ · 52287 × 1 for the cystoscopic intradetrusor injection.
Botox has no administration code of its own — the injection is the procedure, and the CPT follows the site treated: 64615 for chronic migraine, 64616 for cervical dystonia, 64612 for blepharospasm, 67345 for strabismus, 64642 (1 to 4 muscles) or 64644 (5 or more) per extremity for limb spasticity, 64650 for bilateral axillary hyperhidrosis, and 52287 for the cystoscopic intradetrusor injection used for overactive bladder and neurogenic detrusor overactivity. 96372, the general therapeutic injection code, is wrong on every Botox claim — the chemodenervation code already reports the injection. Needle EMG (95874) or electrical-stimulation (95873) guidance bills as an add-on, but only with the extremity, trunk, neck and laryngeal codes: 64616, 64617, and 64642 through 64647. It is not billable with 64615, 64612, 67345, 64650, 64653 or 52287.
CMS's Medically Unlikely Edit for J0585 is 800 Units per day — twice the adult ceiling of 400 Units in any 3-month interval, so it catches a data-entry error rather than authorizing dosing above the label's own ceiling, which binds first in ordinary practice.
Botox is supplied as 100- or 200-Unit vacuum-dried powder in a single-dose vial, reconstituted only with sterile, preservative-free 0.9% sodium chloride before injection. NDC 0023-1145-01 (100 Units) and 0023-3921-02 (200 Units). See the FDA Botox label (BLA 103000) for full dosing and administration instructions.
Botox (J0585, onabotulinumtoxinA, AbbVie/Allergan) is one of five botulinum toxin products billed to payers, each a distinct molecule with its own potency scale: Dysport (J0586, abobotulinumtoxinA, Ipsen), Xeomin (J0588, incobotulinumtoxinA, Merz), Myobloc (J0587, rimabotulinumtoxinB, Supernus) and Daxxify (J0589, daxibotulinumtoxinA-lanm, Revance). Units are not interchangeable between them — a Unit of Botox is not a Unit of Dysport or any other product in the family, and a dose is never converted from one to another. See the HCPCS hub for coding across the full family. The Medicare rate for every quarter is on the cost page →
155 billing units. Botox J0585 bills 1 unit per Unit administered, so the claim's unit count is the same number as the labeled dose — no mg conversion, no rounding.
Report the Units administered on one J0585 line and the Units discarded from the single-dose vial on a second J0585 line with modifier JW. A 25-Unit blepharospasm dose drawn from a 100-Unit vial, for example, bills J0585 × 25 and J0585-JW × 75.
No. Botox vials are single-dose. CMS's single-dose container policy requires the unused remainder after one patient's injection to be discarded and billed as waste on a JW line, not saved for a second patient.
No. Medicare and commercial payers pay the same rate per Unit ($6.514, Q4 2026 ASP+6%) no matter which vial size supplied the dose. The vial size only changes how many Units are drawn and discarded, not the payment rate.
The Medically Unlikely Edit for J0585 is 800 Units per day. A single date-of-service claim above that line is denied unless documentation supports an appeal — and it sits far above the adult ceiling of 400 Units in any 3-month interval, which binds first in ordinary practice.
Data current: pricing Q4 2026 · payer policies Aug 2026
Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (64615, national non-facility); FDA-approved prescribing information (Botox label, AbbVie/Allergan, BLA 103000); CMS single-dose container JW/JZ policy (effective July 1, 2023); CPT codebook administration-code guidance; the CareCost Clearance coverage corpus (29 payers, 771 rules) for onabotulinumtoxinA.
Reviewed September 20, 2026 by Erin Rose, CareCost Estimate founder. Methodology →