All Policies and Precertification
Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.
COVID-19 for Members
COVID-19 for Employers
Hyperhidrosis is the secretion of sweat in amounts greater than physiologically needed for thermoregulation.
It is most commonly a chronic idiopathic (primary) condition; however, secondary medical conditions or medications should be excluded.
Treatment for primary focal hyperhidrosis may be considered medically necessary when any ONE of the following criteria have been met:
Treatment of Hyperhidrosis not meeting the criterial above will be considered not medically necessary
17999
32664
64650
64653
69676
97033
J0585
Any ONE of the following treatments outlined below may be considered medically necessary for the corresponding focal region ONLY when the general criteria outlined above has been met.
NOTE: Sympathectomy for hyperhidrosis treatment of axillary and palmar regions requires an inpatient stay.Initial authorization for botulinum toxin A (Onabotulinumtoxin A) for axillary hyperhidrosis will expire three (3) months from the original authorization date for any diagnosis. Additional authorization may be given if documentation of an objective measurable effect is provided indicating clinical improvement of the condition. Absence of clinical improvement of axillary hyperhidrosis will be considered not medically necessary for further injections of botulinum toxin A (Onabotulinumtoxin A).
Axillary liposuction as treatment for primary hyperhidrosis is considered experimental/investigational and therefore non-covered, because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Treatment of axillary hyperhidrosis not meeting the criteria above will be considered not medically necessary.
15878
Any ONE of the following treatments may be considered medically necessary for the corresponding focal region ONLY when the general criteria outlined above have been met.
NOTE: Injections should occur no sooner than six (6) months apart.
Botulinum toxin B (Rimabotulinumtoxin B), microwave treatment, and radiofrequency ablation for palmar hyperhidrosis are considered experimental/investigational and therefore non-covered, because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Treatment of palmar hyperhidrosis not meeting the criterial above will be considered not medically necessary.
J0587
Any ONE of the following treatments may be considered medically necessary for the corresponding focal regions ONLY when the general criteria outlined above have been met.
Botulinum toxin, lumbar sympathectomy, and microwave treatment for plantar hyperhidrosis are considered experimental/investigational and therefore non-covered, because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Treatment of plantar hyperhidrosis not meeting the criterial above will be considered not medically necessary.
64818
Botulinum toxin, iontophoresis, and microwave treatment for craniofacial hyperhidrosis are considered experimental/investigational and therefore non-covered, because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Treatment of craniofacial hyperhidrosis not meeting the criterial above will be considered not medically necessary.
Secondary Hyperhidrosis: Secondary Gustatory Hyperhidrosis
The following treatments may be considered medically necessary for the treatment of severe gustatory hyperhidrosis when the above general criteria have been met:
Botulinum toxin and iontophoresis for severe gustatory hyperhidrosis are considered experimental/investigational and therefore non-covered, because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Treatment of secondary hyperhidrosis not meeting the criterial above will be considered not medically necessary.
Covered Diagnosis codes for Procedure Codes: J0585, 97033, 64650, 32664
Covered Diagnosis codes for Procedure Codes: J0585, 97033, 64653, 32664
Covered Diagnosis codes for Procedure Codes: 97033
Covered Diagnosis codes for Procedure Codes: 32664
Covered Diagnosis for Procedure Codes: 69676
Non-Covered Diagnosis codes for Procedure Codes 15877, 15878, 17999
L74.52
L74.510
L74.511
L74.512
L74.513
L74.519
Not Applicable
Internal Medical Policy Committee 11-19-2020 changed indications from "any" to any one.
References (PDF)
Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.
Hyperhidrosis is the secretion of sweat in the amounts greater than physiologically needed for thermoregulation.
General medical necessity criteria for the treatment of primary focal hyperhidrosis.
Treatment for primary focal hyperhidrosis may be considered medically necessary when ANY ONE of the following general criteria have been met:
BOTH of the following criteria must be met:
Treatment of Hyperhidrosis not meeting the criteria above will be considered not medically necessary.
Criteria for specific focal regions
ANY ONE of the following treatments may be considered medically necessary for the corresponding focal regions ONLY when the general criteria outlined above has been met.
Axillary Region
Note: Sympathectomy for hyperhidrosis treatment of axillary and palmar regions requires an inpatient stay.
Initial authorization for botulinum toxin A (OnabotulinumtoxinA) for axillary hyperhidrosis will expire in 3 months from the original authorization date for any diagnosis. Additional authorization may be given if documentation of an objective measurable effect is provided indicating clinical improvement of the condition. Absence of clinical improvement of axillary hyperhidrosis will be considered not medically necessary for further injections of botulinum toxin A (Onabotulinumtoxin A).
Axillary liposuction, radiofrequency ablation and microwave treatment for axillary hyperhidrosis are considered experimental/investigational and therefore non-covered. Scientific evidence does not demonstrate the effectiveness of these treatments.
Palmar Region
Note: Injections should occur no sooner than 6 months apart.
Botulinum toxin B (Rimabotulinumtoxin B), microwave treatment, and radiofrequency ablation for palmar hyperhidrosis are considered experimental/investigational and therefore non-covered. Scientific evidence does not demonstrate the effectiveness of these treatments.
Treatment of palmar hyperhidrosis not meeting the criteria above will be considered not medically necessary.
Plantar Region
Botulinum toxin, lumbar sympathectomy, radiofrequency ablation, and microwave treatment for plantar hyperhidrosis are considered experimental/investigational and therefore non-covered. Scientific evidence does not demonstrate the effectiveness of these treatments.
Treatment of plantar hyperhidrosis not meeting the criteria above will be considered not medically necessary.
Craniofacial Region
Botulinum toxin, iontophoresis, radiofrequency ablation, and microwave treatment for craniofacial hyperhidrosis are considered experimental/investigational and therefore non-covered. Scientific evidence does not demonstrate the effectiveness of these treatments.
The following treatment may be considered medically necessary for severe gustatory hyperhidrosis when the above general criteria have been met:
Botulinum toxin and iontophoresis for severe gustatory hyperhidrosis are considered experimental/investigational and therefore non-covered. Scientific evidence does not demonstrate the effectiveness of these treatments.
Treatment of secondary hyperhidrosis not meeting the criteria above will be considered not medically necessary.
Covered Diagnosis codes for Procedure Codes: J0585
Covered Diagnosis codes for Procedure Codes: 64650
Covered Diagnosis codes for Procedure Codes: 64653
Non-Covered Diagnosis Codes for Procedure Codes: 15877, 15878, 17999