Botox is often not covered by health insurance because it is usually used in cosmetic procedures. However, what if you need Botox to treat a medical condition such as a migraine?
Below you’ll find the answer to the question “does insurance cover Botox for migraines?”
Coverage For “Medically Necessary” Procedures
It is normal for health insurance companies to provide coverage for medical procedures as long as they are considered medically necessary to treat a patient’s symptoms and conditions.
However, many health insurance plans do not cover cosmetic procedures and elective ones.
Botox can be used in different ways. The most common thing people think about with Botox is those who get Botox injections to smooth out wrinkles on the face.
However, some doctors (ie. neurologists) may also prescribe Botox as a way to treat migraines.
Does Insurance Cover Botox For Migraines?
Yes, many health insurance plans provide coverage for Botox as a treatment for migraines. This includes Medicare and Medicaid.
Many health insurance plans provide coverage for Botox as a treatment because the Food and Drug Administration (FDA), approves the use of it to treat migraines.
For instance, Original Medicare, also known as Medicare Part A and Part B, can provide coverage for Botox. This remains true as long as it is used to treat migraines.
Original Medicare only provides coverage for Botox treatments if it is considered medically necessary and ordered by your healthcare provider. Original Medicare will also provide coverage for Botox treatment if you have certain medical conditions such as crooked eyes, hyperhidrosis, overactive bladder, eyelid muscle spasms, and upper limb spasms.
Coverage for medically necessary Botox treatment is provided by Medicare Part B. Once approved, Medicare Part B covers 80 percent of the costs of your Botox treatment, and you will pay for the remaining 20 percent.
However, Original Medicare does not provide coverage for Botox injections if it used for cosmetic reasons.
Not all health insurance plans provide coverage for Botox when it’s used to treat migraines. And those who do provide coverage for it will require some conditions first before they provide coverage.
When Do I Qualify for Botox Treatments?
You may need prior authorization to get approved for coverage for Botox treatments for migraines. Also, before your health insurance plan provides coverage for your Botox treatment for migraines, you usually must at least need to have tried and failed two other treatments for migraines.
These may include anti-seizure medications, antidepressants, or blood pressure medications. Also, as per the FDA, health insurance plans do not provide coverage for Botox to treat generic headaches.
For it to be considered, you must at least have 15 or more days of migraines per month with your headaches lasting over four hours or more.
FDA recommends a dosage of 155 units for each treatment. That amount can cost anywhere between $300 to $600 for each treatment.
Many health insurance plans provide coverage for Botox treatments for migraines. But there are some conditions that you need to meet before getting coverage from your health insurance plan.