Hyperhidrosis treatment

Applies to:

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.

Definition

Hyperhidrosis, or excessive sweating, is a medical condition that is defined as sweating beyond what is necessary to maintain thermal regulation.

Medical policy

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.

Non-standard cost-sharing

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.