All plans. Medicare coverage is determined by the Centers for Medicare and Medicaid Services (CMS); if a coverage determination has not been adopted by CMS, the Priority Health medical policy applies.
Hyperhidrosis, or excessive sweating, is a medical condition that is defined as sweating beyond what is necessary to maintain thermal regulation.
Hyperhidrosis - 91451
Hyperhidrosis treatment coverage
Priority Health covers treatment of intractable, disabling primary hyperhidrosis, including treatment with Botulinum Toxin A or B or tumescent liposuction, for the indications described in the medical policy.
When services are covered, they may be subject to non-standard cost-sharing for some members.
If/when commercial employer group and MyPriority® individual plans cover certain surgeries, these surgeries may be covered at a different cost-sharing level than our standard benefit coverage levels.
To verify member cost sharing and coverage, use the Member Inquiry tool and look in the Additional benefits drop-down menu for Certain surgeries benefit information.
Hyperhidrosis treatment authorizations
Authorization is required:
For botulinum toxin injections, to find coverage information, criteria and authorization forms, visit the drug authorization and billing information
Authorization is not required:
For covered procedures. See the medical policy.
Hyperhidrosis treatment billing
See the medical policy for codes that may apply and codes not covered.