Onabotulinumtoxina · Neurology
Botox (J0585) carries a median commercial contracted rate of 100.1 on the Medicare ASP=100 index — 2.5% below the 102.7 typical-acquisition benchmark and 4.0% below the 104.3 Medicare payment line. 59 insurers report contracted rates across 52 states (1,063 priced cells), covering $395M in modeled Part B spend.
Shaded band: 10th–90th percentile across insurers. Darker band: 25th–75th percentile. Solid tick: median. Dashed lines: 100 (Medicare ASP), 102.7 (typical acquisition cost), 104.3 (Medicare payment after sequestration).
All 52 insurers with published rates for this code, ranked highest to lowest. Index is a multiple of Medicare ASP (ASP=100).
| Insurer | Index | vs. acquisition | Practices | States |
|---|---|---|---|---|
| BlueCross BlueShield of Texas | 122.0 | +18.8% | 46 | 17 |
| Regence Idaho | 120.0 | +16.8% | 45 | 6 |
| BlueCross BlueShield of South Carolina | 120.0 | +16.8% | 57 | 6 |
| BlueCross BlueShield of New Mexico | 117.7 | +14.6% | 210 | 3 |
| BlueCross BlueShield of Nebraska | 113.3 | +10.3% | 34 | 7 |
| BlueCross BlueShield of Oklahoma | 113.3 | +10.3% | 83 | 2 |
| Regence Utah | 110.1 | +7.2% | 46 | 5 |
| BlueCross BlueShield of Arkansas | 108.5 | +5.6% | 48 | 21 |
| BCBS North Dakota | 108.5 | +5.6% | 139 | 3 |
| BlueCross BlueShield of Kansas | 107.6 | +4.8% | 60 | 5 |
| Premera Blue Cross | 105.6 | +2.8% | 102 | 9 |
| Aetna | 104.7 | +1.9% | 762 | 51 |
| HMSA (BCBS Hawaii) | 104.4 | +1.7% | 80 | 3 |
| Capital Blue Cross | 103.9 | +1.2% | 92 | 35 |
| Anthem Massachusetts | 103.8 | +1.1% | 64 | 25 |
| Blue Shield of California | 102.8 | +0.1% | 120 | 4 |
| Blue Cross NC | 102.8 | +0.1% | 187 | 52 |
| Blue Cross of Idaho | 102.1 | −0.6% | 58 | 6 |
| BlueCross BlueShield of Wyoming | 102.1 | −0.6% | 44 | 7 |
| BlueCross BlueShield of Louisiana | 100.8 | −1.9% | 54 | 7 |
| Kaiser Permanente | 100.1 | −2.5% | 312 | 8 |
| UnitedHealthcare | 100.1 | −2.5% | 1,080 | 51 |
| Anthem Kentucky | 100.1 | −2.5% | 85 | 9 |
| Anthem Georgia | 100.1 | −2.5% | 72 | 15 |
| Anthem Ohio | 100.1 | −2.5% | 80 | 12 |
| Anthem New Hampshire | 100.1 | −2.5% | 78 | 7 |
| BlueCross BlueShield of Alabama | 100.1 | −2.5% | 91 | 6 |
| Anthem Wisconsin | 100.1 | −2.5% | 154 | 5 |
| Anthem Maine | 100.1 | −2.5% | 76 | 5 |
| BlueCross BlueShield of Rhode Island | 100.1 | −2.5% | 291 | 3 |
| Regence Washington | 100.1 | −2.5% | 74 | 5 |
| Florida Blue | 100.1 | −2.5% | 32 | 5 |
| Centene | 100.1 | −2.5% | 510 | 37 |
| Anthem Virginia | 100.1 | −2.5% | 74 | 20 |
| BlueCross BlueShield of Massachusetts | 100.1 | −2.5% | 57 | 10 |
| Anthem Indiana | 100.1 | −2.5% | 141 | 24 |
| Anthem New York | 100.1 | −2.5% | 72 | 15 |
| Regence Oregon | 100.1 | −2.5% | 58 | 7 |
| Regence BlueCross BlueShield | 100.1 | −2.5% | 56 | 14 |
| Anthem Nevada | 100.1 | −2.5% | 194 | 4 |
| Anthem Missouri | 100.1 | −2.5% | 44 | 11 |
| Anthem Connecticut | 100.1 | −2.5% | 66 | 5 |
| Harvard Pilgrim Health Care | 100.1 | −2.5% | 229 | 10 |
| CareFirst BlueCross BlueShield | 100.1 | −2.5% | 59 | 18 |
| Anthem California | 100.0 | −2.6% | 64 | 4 |
| Wellmark BCBS (Iowa/South Dakota) | 99.9 | −2.7% | 78 | 10 |
| BlueCross BlueShield of Minnesota | 99.9 | −2.7% | 79 | 8 |
| BlueCross BlueShield of Tennessee | 99.9 | −2.7% | 61 | 10 |
| Horizon BCBS of New Jersey | 99.6 | −3.0% | 42 | 6 |
| Cigna | 96.2 | −6.3% | 636 | 52 |
| BlueCross BlueShield of Michigan | 95.1 | −7.4% | 63 | 7 |
| BlueCross BlueShield of Arizona | 84.1 | −18.1% | 38 | 19 |
Medicare's payment limit for Botox moved +5.5% between Q1 2022 and Q2 2026. Because contracted rates are set as a multiple of ASP, a rising denominator lifts every contracted rate tied to it.
Solid dots: finalized CMS ASP quarters. Hollow dots: preliminary. Values are the Medicare payment limit (ASP + 6%, pre-sequestration) per billing unit.
| Year | Part B spend | Dosage units (M) |
|---|---|---|
| 2019 | $367M | 63.8 |
| 2020 | $331M | 57.0 |
| 2021 | $366M | 63.3 |
| 2022 | $415M | 68.3 |
| 2023 | $445M | 71.8 |
| 2024 | $479M | — |
| 2025 | $395M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 119.1 | 7 |
| Nebraska (NE) | 110.4 | 9 |
| Idaho (ID) | 110.1 | 13 |
| Oklahoma (OK) | 107.6 | 9 |
| Arkansas (AR) | 107.6 | 10 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| South Carolina (SC) | 100.1 | 9 |
| New Jersey (NJ) | 100.1 | 15 |
| Rhode Island (RI) | 100.1 | 9 |
| North Dakota (ND) | 100.1 | 7 |
| Florida (FL) | 100.1 | 35 |
At the median contracted rate, this code models a −$2,532 shortfall per $100,000 of acquisition-benchmark drug cost purchased — illustrative modeled margin exposure, not a claim about any single practice's actual reimbursement.
Based on 1,063 priced contract cells across 59 insurers and 52 states. These are insurers' contracted rates from published machine-readable files — not amounts actually paid on a claim, and not a guarantee of coverage or reimbursement. CareCost Estimate Infusion Reimbursement Index, Issue 01 (Q2 2026), v2.0. CC-BY 4.0. A drug-specific acquisition estimate exists in our warehouse but derives from ASP itself, so we do not print it — the flat 102.7 ODACS benchmark is the honest comparator here.
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