(099) HOW MUCH IS ENOUGH FOR BOTOX(R) & HOW MUCH BOTOX(R) IS ENOUGH? A REVIEW OF BOTULINUM TOXIN INJECTIONS FOR THE TREATMENT OF HYPERTONIC PELVIC FLOOR
Authors: Dumas K , Mikkilineni A , Odenwald E , Bahng J , Cigna S 
Published: June 2024

Abstract

Introduction
Botulinum toxin (BT) is a useful adjunct in the treatment of hypertonic pelvic floor muscles. By blocking the release of acetylcholine, a necessary neurotransmitter for muscle contraction, it facilitates muscle relaxation. These paralytic effects effectively disrupt painful muscle spasms and help patients make further progress in physical therapy when otherwise hindered by painful muscle spasms. Despite having robust data to support the off-label use of BT for the treatment of myofascial pain, there is limited data about its use for the treatment of pelvic floor myofascial pain. Additionally, there is no data about insurance reimbursement or the financial costs to patients undergoing pelvic floor muscle treatment with BT injections.

Objective
1. Determine how many injections of BT patients receive for the treatment of hypertonic pelvic floor 2. Determine insurance reimbursement and financial costs to patients undergoing pelvic floor muscle treatment with BT injections.

Methods
Data was first collected by building a report in Epic to identify all patients seen in our department between 1/1/2022 to 10/31/2023 for a BT-related visit. Patient were further stratified based on CPT code 96372, indicating that they received pelvic floor BT injections. Fifty-one patients were identified. Charts were reviewed to determine how frequently patients returned for BT administration & to determine how much patients had to pay for BT treatment after filing with insurance.

Results
A total of 51 patients received pelvic floor muscle BT injections over the course of 61 patient encounters. Forty-three patients (84%) received BT once, 6 patients (12%) received BT twice, and 2 patients (4%) received BT 3 times. Of the 8 patients who required additional BT treatment, the average time between subsequent BT injections was 83 days. At our institution, the absolute charge for 100 units of BT was $1,068.16 without insurance. All patients treated had active insurance, and all 61 patient encounters were billed through insurance. At the time of this review, 20 patients encounters (33%) were still pending review with insurance, 41 patient encounters (67%) had been reviewed. Of these 41 patient encounters, 30 (73%) were accepted through insurance; 11 (27%) were denied. Nineteen administrations of BT were completely covered by insurance (no self-pay); 11 administrations of BT were partially covered through insurance. For patients that received partial or total coverage through their insurance company, the average self-pay cost for 100 units of BT was $66.77.

Conclusions
Most patients required one visit for pelvic floor muscle treatments with BT, and only occasionally required more than one visit. Prospective studies are needed to quantify and quality patient’s improvement in pain following each BT treatment. In the majority of cases, when BT was filed through insurance, it was at least partially approved. Without insurance, the charge for 100 units of BT was $1,068; when approved through insurance, the average self-pay cost for 100 units of BT was $66.77.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Patty Brisben Foundation.