- Quantity Limit: 8 capsules per 1 day(s).
- 1; 1;
- Quantity Limit: 10 grams per 30 day(s).
- Blepharospasm, Cervical Dystonia:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
Chronic Sialorrhea, Spasticity: Adult, Spasticity: Lower Limb:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Pediatric Upper Limb Spasticity, Spasticity: Upper Limb:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
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