Does Medicare Cover Botox?

Last Updated : 09/10/20183 min read

What is Botox used for?
According to Botox.com and the U.S. National Library of Medicine (NIH), Botox, also called Botulinum toxin type A, can treat a variety of cosmetic and medical problems including:

  • Facial wrinkles
  • Severe underarm sweating when topical medicines do not work
  • Strabismus (misaligned eyes) and abnormal spasms of the eyelids
  • Abnormal head position and neck pain associated with cervical dystonia
  • Increased muscle stiffness in elbow, wrist, finger, thumb and ankle
  • Chronic migraines (15 or more days of migraines each month or a headache lasting 4 or more hours each day)
  • Overactive bladder and incontinence when other types of medicine cannot be taken

Botox Cosmetic is a prescription medicine injected into the muscles to temporarily improve forehead lines, crow’s feet lines and frown lines between the eyebrows, according to Botoxcosmetic.

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com. Almost 11 million vials of Botox Cosmetic have been sold in the United States. There is no generic form of Botox Cosmetic.

What is Botox?

Botox is made from the same toxin that causes the life-threatening type of food poisoning botulism, according to the NIH. Small doses of the bacterium Clostridium botulinum in Botox can treat health problems. The Botox injection works by paralyzing or weakening certain muscles or by blocking certain nerves. Botox injections are effective for three months to a year, depending on what is being treated.

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Does Medicare cover Botox?

Medicare coverage for Botox is based on medical necessity. Medicare may cover Botox for certain medical reasons, such as Botox for migraines, but not for cosmetic reasons, such as Botox for crow’s feet lines. Medicare coverage guidelines for cosmetic Botox might fall under the guidelines for cosmetic surgery. Medicare doesn’t cover cosmetic surgery unless it’s needed because of an accidental injury or to improve the function of a malformed body part.

Talk to your doctor about whether Botox will be effective treatment for you. Tell your doctor all the medicines you take, including prescription and nonprescription medicines, vitamins and herbal products. Combing Botox with certain medicines may cause serious side effects, according to Botox.com.

Do you have more questions about Medicare coverage of Botox?

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