Does Medicare Cover Botox For Migraines?

Botulinum toxin, commonly known by its shorter name, Botox©, has been around since the late 80s.

It is an injectable treatment most people think of as a treatment for wrinkles. Though many think it’s just for cosmetic purposes, Botox offers some great medical benefits too.

It is a highly effective muscle relaxant and can treat some medical conditions due to this effect. One medical condition doctors may use Botox to treat is migraine headaches.

If you are thinking about having a Botox treatment to help with migraines, you may be wondering, “Does Medicare cover Botox For Migraines?” In this article, we answer that question in clear, plain English. You will also find the average costs of Botox and other helpful info.

Does Medicare Cover Botox For Migraines?

The short answer is yes. Medicare will cover the cost of Botox for migraines. But not 100% of the time. As is often the case with Medicare, you must meet certain conditions in order for Medicare to pay for your asthma inhaler. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) usually does not provide coverage for Botox. That is because most of the time, people use Botox for cosmetic reasons. If that’s your plan, you are out of luck. Medicare will not cover Botox if you plan to use it to improve your appearance (ie. removing wrinkles).

However, Medicare may provide coverage for a Botox treatment if it is considered medically necessary. For a Botox treatment to be considered medically necessary, it has to be used to treat a specific medical condition.

Medicare will cover Botox if it will be used for treating your Migraine. Other medical conditions that can be treated using Botox that Medicare covers include:

Severe neck and muscle spasms

Overactive bladder
Overactive sweat glands
Crossed eyes
Temporomandibular joint or TMJ disorder

You will need a prescription from your healthcare provider for Medicare to cover Botox injections for a medical condition.

Part C Coverage

Medicare Advantage (Medicare Part C) also does not provide Botox treatment coverage if it’s for cosmetic purposes. However, just like with Original Medicare, Medicare Part C may provide coverage for Botox injections if it is medically necessary (ie. to treat a migraine) and if your healthcare provider prescribes it.

Here are the steps that you need to follow for Medicare or Medicare Advantage to provide coverage for your Botox:

Have your Medicare-approved healthcare provider submit a request to Medicare. The document must state why it is medically necessary for you to take Botox.
Send documents of your medical condition (in this case, Migraine) to Medicare. You may also inform them through that document that you have tried several medications to treat your Migraine, but none have worked.
Contact Medicare through their number, 800-MEDICARE (800-633-4227), inform them of your condition (Migraine), and ask if you are eligible for coverage. The Medicare representative might tell you of the documents that you may need or the steps that you need to take for them to cover Botox.

How Much Does Botox Cost?

The average cost of a single unit of Botox usually cost somewhere between $10 and $15.

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.