Does Medicare Cover Botox For Overactive Bladder?

Most of the time, Botox therapy is considered a cosmetic procedure because people use it as a way to get rid of wrinkles. However, there are cases in which Botox therapy is used for a medically necessary reason. One situation in which Botox can be used is to help with an overactive bladder.

If this is a treatment you might need to get, a common question you have is, “does Medicare cover Botox for overactive bladder?” In this article, we answer that question in clear, plain English. We also provide information about what this treatment costs.

Does Medicare Cover Botox For Overactive Bladder?

The short answer is yes. Medicare will cover the cost of Botox as a treatment for an overactive bladder. 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

Original Medicare (Medicare Part A and Part B) provides coverage for Botox as a treatment for an overactive bladder. Medicare provides coverage for your Botox treatment if it is considered medically necessary. The treatment must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

While most of the time Original Medicare does not provide coverage for Botox therapy, they will cover it if it will be used for treating an overactive bladder. Original Medicare also provides coverage for Botox treatment for the following medical conditions:

Chronic migraines
Crooked eyes
Eyelid muscle spasms
Hyperhidrosis
Upper limb spasms

However, there are also certain cosmetic Botox therapies that are medically necessary. That is the case if your cosmetic Botox surgery will take place due to an accident or injury.

Once approved, coverage for medically necessary Botox treatment is provided by Medicare Part B. Medicare Part B will cover 80 percent of the costs of Botox treatment for an overactive bladder. You will pay for the remaining 20 percent as coinsurance.

Part C and Part D Coverage for Botox for Overactive Bladder

Medicare Advantage plans (Medicare Part C) also provide coverage for Botox treatment for an overactive bladder. They cover everything Original Medicare covers, as well as some additional benefits. However, exactly what these Part C plans cover and how much the costs for this coverage is will vary depending on the specifics of your plan.

Medicare Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you.

Medicare Part D plans also provide coverage for medications to treat an overactive bladder. Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Does Botox For An Overactive Bladder Cost?

A vial of 200 units of Botox usually costs around $1,500. This price varies depending on the provider.

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.