Insurance and Reimbursement
If you treat hyperhidrosis you know that excessive sweating is serious - and that hyperhidrosis significantly impacts daily life. As a serious medical condition with substantial negative effects on physical, emotional, and social well-being, hyperhidrosis deserves to be treated seriously by health insurance organizations. A healthcare provider's advocacy for patients with hyperhidrosis is invaluable - thank you for all that you do to help patients access care. Patients advocating for themselves is also important, of course, and patients should be encouraged to be in frequent contact with their insurance providers, to ask to see exact policies, and to be the "squeaky wheel."
As you consider treatment options for patients and their cost effectiveness, it can be noted that systemic oral medications such as anticholinergics have been in use for many years and are on most formularies and often available in generic forms. These medications can be cost effective as either an adjunctive treatment or on their own. Recently, the International Hyperhidrosis Society and two of its physician leaders conducted an in-depth webinar all about the use of oral medications to treat hyperhidrosis. You can "watch the full video here."
Additional useful resources are available below:
ICD-10 Codes (Effective Oct. 1, 2015)
L74.5 - Focal Hyperhidrosis (L74.5 and L74.51 should not – however - be used for reimbursement purposes as there are multiple more specific codes)
L74.51 - Primary Focal Hyperhidrosis
L74.510 - Primary Focal Hyperhidrosis, Axilla
L74.511 - Primary Focal Hyperhidrosis, Face
L74.512 – Primary Focal Hyperhidrosis, Palms
L74.513 – Primary Focal Hyperhidrosis, Soles
L74.519 – Primary Focal Hyperhidrosis, Unspecified
L74.52 - Secondary Focal Hyperhidrosis
L74.8 - Other Eccrine Sweat Disorders
L74.9 - Eccrine Sweat Disorder Unspecified
R61 - Generalized Hyperhidrosis
Iontophoresis Procedure Codes
97033 – Iontophoresis, each 15 minutes, clinicians typically bill for 2-4 units depending on how many areas are treated.
99211- Pertains to an evaluation and management (E/M) service. Defined as an office or other outpatient visit “that may not require the presence of a physician.” Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services.
99213 - Can be utilized for a mid-level outpatient or inpatient office visit. It is a level three code that should be used for an established patient.
Use -25 modifier if there is significant, separately identifiable evaluation and management service by the same clinician on the same day of the procedure or other service.
Botulinum Toxin Injection Procedure Codes
64650 - Chemodenervation of eccrine glands, axillae
64653 - Chemodenervation of eccrine glands, other areas (eg, scalp, face, neck)
64999 - Other procedure of the nervous system (use for extremities, i.e. hands and feet)
J0585 - Injection, onabotulinumtoxin A, per unit
The resources listed below provide additional information, downloadable forms, and support networks to help you work with patients, their health insurance plans, and even employers to obtain adequate reimbursement for the vital hyperhidrosis treatments you provide.
- Find out if health plans cover hyperhidrosis treatments
Insurance companies may already cover hyperhidrosis treatments. Use our list of links to U.S. public hyperhidrosis coverage policies and other third-party payers to find out. If we don’t have a particular one listed, have your staff call the health insurance organization to find out what it is (then please send us the link, if there is one, so we can post it.)
- Calculate the cost of hyperhidrosis
This checklist can help you and your patients to calculate how much money they already spend managing excessive sweating – along with other costs. Use the answers to the questions provided and the key Hh facts to help convince insurance plans that hyperhidrosis treatments warrant reimbursement/coverage. Or, if patients have to pay for treatments out-of-pocket, the checklist may help them to see that the investment makes economic, as well as emotional, sense.
- Download a Letter of Medical Necessity
Add evidence to the case, download this sample Letter of Medical Necessity and submit it to the insurance company on behalf of your patient as proof that his/her hyperhidrosis needs treatment.
- Download Hyperhidrosis Preauthorization Request Form
Similar to the Letter of Medical Necessity, this form should be completed and submitted to the insurance company. It demonstrates that a patient has been diagnosed with hyperhidrosis, lists the treatments that he/she has tried (and that have been unsuccessful), and states the treatment that you are now recommending.
- Download Medical Insurance Statement Form for the purchase of a home-use iontophoresis device
Patients looking to purchase an iontophoresis device to treat hyperhidrosis of hands, feet or (sometimes) underarms may be able to receive reimbursement for a home-use iontophoresis device. Download useful forms and learn more about iontophoresis and insurance coverage.
- Get help with Botox reimbursement or savings
If you are seeking to help patients with reimbursement for treatment with Botox, you may find help through the Botox Savings Program, myAbbVieAssist (for the uninsured or underinsured) or BOTOX ONE.
- Download the Qbrexza Patient Savings Card. Eligible patients with a valid prescription from their medical provider can access Qbrexza using the Patient Savings Card.
- Consider whether your patients are good candidates for research trials.
While not technically insurance-related, clinical trials are another potential avenue for anyone seeking treatment for hyperhidrosis. To find out whether there are any current hyperhidrosis studies recruiting patients, visit our research opportunities page.
- Subscribe to our free News Blog. Often during our medical education sessions, we allow patients to receive free treatment. We always announce these opportunities to our subscribers first.