Health Policy Affairs

On May 4, 2026, SIR and the American College of Radiology (ACR) submitted joint comments to the Centers for Medicare and Medicaid Services (CMS) contractors Noridian, CGS, NGS, WPS and Palmetto on its proposed local coverage determination (LCD) for botulinum toxin injections, urging the inclusion of image-guided preoperative abdominal wall botulinum toxin (BTX) injection as a covered indication to facilitate large ventral hernia repair. The growing body of evidence demonstrating that preoperative BTX injection improves abdominal wall compliance, facilitates tension-reduced fascial closure, and reduces the need for more invasive surgical component separation techniques in patients with large or complex hernias was highlighted. SIR and ACR encourage each of the Medicare contractors to recognize BTX injection as a valuable, minimally invasive adjunct to complex abdominal wall reconstruction.