Limited Use Note(s)

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CLOSTRIDIUM BOTULINUM NEUROTOXIN TYPE A100 LD50 Units Pd for Inj-Vial Pk
Reason For Use CodeClinical Criteria
130To reduce the subjective symptoms and objective signs of cervical dystonia (spasmodic torticollis) in adults.
LU Authorization Period: 1 year
412For the management of focal spasticity, due to stroke or spinal cord injury in adults.
LU Authorization Period: 1 year
421For the treatment of blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in adults.
LU Authorization Period: 1 year
NOTE: Xeomin should be administered personally by a neurologist or a physician with equivalent post-graduate training and experience with neuromuscular disorders.