{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T07:17:25Z","timestamp":1773299845844,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T00:00:00Z","timestamp":1608249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize reimbursement trends and providers for chronic migraine (CM) chemodenervation treatment within the Medicare population since the introduction of the migraine\u2010specific CPT code in 2013.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We describe trends in procedure volume and total allowed charge on cross\u2010sectional data obtained from 2013 to 2018 Medicare Part B National Summary files. We also utilized the 2017 Medicare Provider Utilization and Payment Data to analyze higher volume providers (&gt;10 procedures) of this treatment modality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The total number of CM chemodenervation treatments rose from 37,863 in 2013 to 135,023 in 2018 in a near\u2010linear pattern (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.999) and total allowed charges rose from ~$5,217,712 to $19,166,160 (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.999). The majority of high\u2010volume providers were neurologists (78.4%; 1060 of 1352), but a substantial proportion were advanced practice providers (APPs) (10.2%; 138 of 1352). Of the physicians, neurologists performed a higher mean number of procedures per physician compared to non\u2010neurologists (59.6 [95% CI: 56.6\u201362.6] vs. 45.4 [95% CI: 41.0\u201350.0],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). When comparing physicians and APPs, APPs were paid significantly less ($146.5 [95% CI: $145.6\u2013$147.5] vs. $119.7 [95% CI: $117.6\u2013$121.8],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). As a percent of the number of total beneficiaries in each state, the percent of Medicare patients receiving \u22651 CM chemodenervation treatment from a high\u2010volume provider in 2017 ranged from 0.024% (24 patients of 98,033 beneficiaries) in Wyoming to 0.135% (997 of 736,521) in Arizona, with six states falling outside of this range.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Chemodenervation is an increasingly popular treatment for CM among neurologists and other providers, but the reason for this increase is unclear. There is substantial geographic variation in its use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.14040","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T14:16:05Z","timestamp":1608300965000},"page":"373-384","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Characterizing the providers of and reimbursement for chronic migraine chemodenervation among the Medicare population"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1964-7109","authenticated-orcid":false,"given":"Sina J.","family":"Torabi","sequence":"first","affiliation":[{"name":"Division of Otolaryngology Department of Surgery Yale University School of Medicine New Haven CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Kasle","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Department of Surgery Yale University School of Medicine New Haven CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily L.","family":"Savoca","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Department of Surgery Yale University School of Medicine New Haven CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher H.","family":"Gottschalk","sequence":"additional","affiliation":[{"name":"Division of Headache Medicine Department of Neurology Yale University School of Medicine New Haven CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Peter","family":"Manes","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Department of Surgery Yale University School of Medicine New Haven CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2016.93"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)31678-6"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-019-0993-0"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1416"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2000.110960"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2010.01678.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102410364676"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102410364677"},{"key":"e_1_2_8_10_1","volume-title":"Botulinum Toxin Injection","author":"Carolina BBoN"},{"key":"e_1_2_8_11_1","volume-title":"Botox (OnabotulinumtoxinA)\u2014Injection Workbook for Chronic Migraine: Guidance for Identifying BOTOX Candidates, the Injection Procedure, and Discussing Treatment with Patients","author":"Ireland AP","year":"2016"},{"key":"e_1_2_8_12_1","volume-title":"Prior Authorization for Certain Hospital Outpatient Department (OPD) Services","author":"Services CgCfMM","year":"2020"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.0235"},{"key":"e_1_2_8_14_1","first-page":"61142","volume-title":"Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; 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