Botox or botulinum toxin has been used since 1987 to lessen wrinkles in the skin. But the muscle relaxation benefits have also been used to treat several medical conditions. Medicare only covers medically necessary and FDA-approved treatments. However, Medicare won’t cover cosmetic treatments such as wrinkle treatments.

Medicare Coverage for Botox

Medicare covers botox treatments for medical conditions. However, for this treatment to be covered, your healthcare provider must show that it’s medically necessary to treat a medical condition. Medicare covers several health conditions for medical reasons.

Medicare Coverage for Non-Cosmetic Botox Usages

Bladder Dysfunction

Botox injections help reduce urinary incontinence caused by an overactive bladder.

Cervical Dystonia

Cervical Dystonia is a painful condition that causes your neck muscles to contract involuntarily. It causes your head to twist into an uncomfortable position.

Chronic Migraine

Chronic Migraines are migraines that occur more than 15 days a month. Botox injections reduce headache frequency and symptoms.

Eye Twitching

Botox injections help to relieve the twitching muscles around the eye.

Hyperhidrosis

Hyperhidrosis is a condition in which excessive sweating occurs. This condition can happen when the temperature isn’t hot and you’re not experiencing physical exertion.

Lazy Eye

Lazy eye is an imbalance in the muscles that position the eye.

Muscle Contractures

Muscle contractures are a symptom that occurs in certain neurological conditions, such as cerebral palsy. These contractures can cause your limbs to pull towards the center of your body. Sometimes Botox injections can relax the contracted muscles.

Botox is a trademarked name, but many use it to describe all the seven types of botulinum toxin. Botulinum toxin types A and B are the only options that have cosmetic or medical uses.

Botox Costs Under Original Medicare

Part A

If your stay in the hospital is more than 60 days, you’ll begin to pay a daily copay for each additional day you are in the hospital as an inpatient under Part A. There is no cost for the first 20 days if you are in a skilled nursing facility. Furthermore, once you exhaust those days, you’ll pay a per-day copay up until 100 days.

Part B

Medicare Part B administers your health care for outpatient procedures and services. Part B also covers your doctor’s office visits, durable medical equipment, and drugs administered in the doctor’s office. Once you meet your small annual Part B deductible, you’ll be responsible for a 20% coinsurance and applicable excess charges.

Botox Costs With a Medicare Supplement

These plans are secondary to Medicare. They will help pay for any services that Original Medicare covers, including Botox.

Botox Costs Under Medicare Advantage

Medicare Advantage plans are another name for Medicare Part C. This Medicare health insurance is required to cover all the same services as Medicare Parts A and B. You will want to look at your plan benefits to see if and how it will cover Botox.

FAQs

Does Medicare cover Botox?

Medicare coverage for Botox injections is limited to FDA approval and conditions considered Medically necessary. Furthermore, Medicare does not cover injections for cosmetic purposes.

Does Medicare Part B cover Botox injections?

Medicare Part B covers Botox Injections. These injections occur in a doctor’s office or outpatient facility.

What diagnosis is Botox approved to treat with Medicare?

Some health conditions that Medicare covers the usage of Botox injections as a treatment option include Cervical Dystonia, Lazy Eye, Muscle Contractures, Hyperhidrosis, Chronic Migraine, Bladder Dysfunction, Eye Twitching, and Muscle Spasms.

Prior authorization and proof from your doctor that the treatment is medically necessary could be required before the treatment is approved and covered by Medicare.

Does Medicare Part B pay for Botox for migraines?

Botox is a Medicare Approved treatment for beneficiaries that suffer from chronic migraines.

What is the average cost of Botox in the US?

The average dosage is 155 units of Botox per injection. According to the American Migraine Foundation, the average treatment cost is $300 to $600.

How to Get Help With Medicare Coverage for Botox Injections

Botox injections can be costly with Original Medicare only, and Many Medicare beneficiaries enroll in a Medigap insurance plan or Medicare Advantage plan to help offset the costs. We can assist you with finding the coverage that fits your needs. Our licensed insurance agents have access to all the programs in your area.

Then we educate and assist you with your Medicare questions and needs. Give us a call to fill out our online request form for assistance with your Medicare options.

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by Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.