Most of the time, Original Medicare does not provide coverage for Botox. That is because Botox treatment is usually for cosmetic reasons rather than as a medically necessary procedure. But if it will be used for a medically necessary reason, Original Medicare may pay for it. Is treating hyperhidrosis, or excessive sweating, one of these medically necessary reasons?
This leads a lot of people to ask, “does Medicare cover Botox for hyperhidrosis?” In this article, we answer that question in clear, plain English. You will also find data on the average costs of Botox treatment for this condition.
Does Medicare Cover Botox For Hyperhidrosis?
The short answer is yes. Medicare will cover the cost of Botox as a treatment for hyperhidrosis. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your Botox treatment. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for Botox as a treatment for hyperhidrosis. However, the treatment has to be medically necessary if you want Medicare to pick up the costs for you. The treatment must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
Even though most of the time Original Medicare does not provide coverage for a Botox treatment, they will provide coverage for Botox as a treatment for hyperhidrosis. Original Medicare also provides coverage for Botox treatment for the following medical conditions:
- Chronic migraines
- Crooked eyes
- Eyelid muscle spasms
- Overactive bladders
- Upper limb spasms
Once approved, coverage for medically necessary Botox treatment is provided by Medicare Part B. Medicare Part B will provide coverage for Botox treatment for hyperhidrosis if symptoms of the condition still persist even after the use of prescription antiperspirants.
The Food and Drug Administration has approved Botox treatment for hyperhidrosis.
Medicare Part B will cover 80 percent of the costs of Botox treatment for hyperhidrosis. You will pay for the remaining 20 percent as coinsurance.
Part C Coverage for Botox for Hyperhidrosis
Medicare Advantage plans (Medicare Part C) also provide coverage for Botox treatment for hyperhidrosis. By law these plans have to cover everything Original Medicare covers. Part C plans, however, offer additional coverage that Part A and Part B do not. The specifics of what a Part C plan covers, and the costs of that plan, will vary depending on the plan you select.
How Much Does Botox For Hyperhidrosis Cost?
Botox for hyperhidrosis costs $1,000 for both underarms. Usually a patient needs to repeat the treatment every 7-16 months so this is an ongoing expense.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover Sleep Number beds?