Does Medicare Cover Botox?
Botox injections are best known as cosmetic treatments for those who want to reduce the appearance of facial wrinkles and make their skin look smooth and young. However, Botox injections are also used to treat medical conditions that are caused by muscle disorders.
If your health care provider suggests you get Botox injections for a medical condition, your Medicare benefits might cover them. It will depend on the type of treatment you need and if the Botox is considered medically necessary.
Does Medicare cover Botox?
Medicare doesn’t cover Botox injections if they are solely for cosmetic reasons. However, Original Medicare Part B (medical insurance) might cover Botox injections if your health care provider certifies that you need them to treat a medical condition and that this treatment is FDA-certified. Health conditions that might qualify you for getting this benefit include the following:
- Cervical dystonia (neck spasms), a painful condition that causes neck muscles to contract involuntarily
- Amblyopia (lazy eye), a condition caused by an imbalance of the eye muscles
- Involuntary muscle contractures
- Hyperhidrosis (excessive sweating)
- Excessive eye twitching due to muscle contracture
- Chronic migraines
- Urinary incontinence due to a dysfunctional bladder
- Strabismus (crossed eyes) caused by muscle disorders
- Temporomandibular joint disorder
To be eligible for Medicare coverage, your physician must accept Medicare assignment, and she must certify that the Botox injections are medically necessary. If Medicare provides authorization for the procedure, Part B covers 80 percent of the final approved amount. You pay 20 percent and your annual Part B deductible.
In the case of Botox injections for use in FDA-certified treatments, it might be a good idea to ask for pre-authorization from Medicare, or from your Medicare Advantage (Part C) provider, before going ahead with them.
To get preauthorization from Medicare, your Medicare-affiliated health care provider must submit a written request to Medicare, detailing the reasons why Botox is a medically necessary treatment for your health condition. This request must be accompanied by medical records showing the diagnosis and documented symptoms regarding your condition and what other treatments you’ve undergone for it.
Do Medicare Advantage plans cover Botox injections?
All Medicare Advantage (Part C) plans are required by federal law to provide the same benefits (at minimum) that Original Medicare Parts A and B provide. Most Part C plans also offer additional coverage and extra benefits that depend on the provider and the type of plan you enroll in.
If your Botox treatment is authorized as being medically necessary by Medicare, your Part C plan must cover it. However, your plan may require that you get treatment from health care providers that are included in the plan’s set network of providers to be eligible for coverage. You should check your printed policy or call your provider for details if you aren’t sure about your restrictions.
How much do Botox injections cost without Medicare coverage?
The national average cost of Botox per unit in the United States is $10 to $20. For every application of Botox, several units may be necessary, depending on the injection site and the individual. Together with the price of Botox per unit, there are additional charges for supplies like gloves, needles, and anesthetic. You will also have to pay the physician’s fees and facility fees if they apply.