ORIGINAL MEDICARE
Medicare guidelines for Botox treatments include Botox injections to treat certain medical conditions. Further, the treatment must have FDA approval. Botox uses many forms a botulinum toxin to block specific nerves or paralyze confined muscle movement. Botox may serve many purposes, from cosmetics to medical. There’s more to know about this medication and the health conditions it treats. The best part is, if you meet the guidelines – Medicare may cover most of the costs.
Does Medicare Cover Botox
The uses of Botox go beyond the skin, and Medicare coverage for Botox treatments are available for several medical conditions. If a doctor deems it medically necessary to treat you, Medicare likely covers the cost. Doctors use injections to treat excess sweating, leaky bladders, eye squints, and migraines. But, the primary use remains to reduce fine lines and facial wrinkles.
The FDA approves treatments for things like cervical dystonia, a nerve disease.
What Botox Treatments Does Medicare Cover?
- Chronic migraines
- Crooked eyes
- Extreme underarm sweating
- Eyelid muscle spasms
- Overactive bladders
- Upper limb spasms
How Much Does Botox Injections Cost
Most health insurance plans cover medical Botox treatment under FDA approval. Usually, the dosage of 155 units costs around $300 to $600 for each treatment. Medicare’s injection cost may vary depending on plan coverage, medical condition, and the type of injection. Most plans have coverage for chronic migraines.
Contact your plan before getting any Botox injections. Ask your insurance provider if you need any paperwork for Medicare coverage to apply.
What are the Medicare Guidelines for Botox Injections?
Is Cosmetic Botox Covered by Medicare?
Does Medicare Cover Botox for Migraines?
Yes, Medicare covers Botox for migraines, although it’s not intended for individuals who endure less than 15 days of headaches in a month. The FDA approves Botox for chronic migraines as an effective treatment. Headaches lasting 15+ days of the month are known as migraines.
Dr. Andrew Blumenfeld, Director, The Headache Center of Southern California, says:
“The more frequent the headaches, the better the patient does with Botox.”
Look for a neurologist or headache specialist that accepts your plan if you are considering Botox treatment.
Will Medicare Reimburse You For Botox Treatments?
Botox reimbursement from Medicare is rare; yet, you may have to file in some instances. For example, if you visit your doctors’ office under Medicare, your doctor may not bill Medicare. If this happens, you may be required to pay the cost.
Though this may be a situation when filing a Medicare Reimbursement claim is appropriate.
However, this rarely happens. Most of the time, you receive a medical bill; it means your doctor isn’t accepting Medicare assignment.
FAQ’s About Medicare and Botox Treatments
How to Get Extra Medicare Coverage for Botox Treatments
Botox is an expensive service, and your Out Of Pocket cost may increase depending on the number of units you need to treat your condition. Medicare pays 80%, and the other 20% becomes an out of pocket cost.
Because Botox is only a temporary fix – you may need treatment again in 4-6 months. Over time, that 20% can add up to a financial burden.
Supplement insurance picks up the remaining 20% for copayments, coinsurance, and deductibles. Medicare with a supplement plan is the best way to get help covering costs for procedures like Botox.
Fill out our online rate form or give us a call today. One of our Medicare experts can help you to understand the plans and compare rates to save you the hassle.
About The Author
We just had a patient just tell us that beginning in September, Medicare will require authorization for Botox? Is this true? How would we go about getting authorization?
Hi Bobbie! Outside of some durable medical equipment, there is no prior authorization when it comes to Medicare claims. However, this is not the case with Medicare Advantage. If your patient has a Medicare Advantage plan, it’s the carrier requiring prior authorization, not Medicare. As of now, we have not heard anything about Medicare making changes where they require prior authorization for Botox. We will update this page accordingly if we do!
In regards to frequency of Botox – does it have to be every 84 days (12 weeks) or can one be seen sooner? Like every 80 days (10 weeks)? What are Medicare’s guidelines?
Hi Tami! As long as the doctors provide both diagnostics codes and services codes on the claim form, Medicare should approve the injections as often as your doctor finds them medically necessary.
It would be helpful if there was information about the frequency of Botox injections, how long in between treatments does Medicare allow.
Hi Tina! Botox injections fall under Part B. As long as the doctors provide both diagnostics codes and services codes on the claim form, Medicare should approve the injections as often as your doctor finds them medically necessary. You’ll have to pay the 20% coinsurance for each one. However, if you have a Medigap plan, the coinsurance will be covered. I hope this helps!