Treatment of primary hyperhidrosis (705.21), including topical aluminum chloride, botulinum toxin (J0585), endoscopic transthoracic sympathectomy (32664), and surgical excision of axillary sweat glands (11450-11451) is considered eligible only in the small subset of patients with documented medical complications such as skin maceration with secondary infection. In the absence of documented medical complications, treatment for primary hyperhidrosis is considered not medically necessary, and is not covered. A participating, preferred, or network provider cannot bill the member for the denied service.

Eligibility of botulinum toxin type A, BOTOX (J0585), in the treatment of hyperhidrosis is limited only to treatment for primary axillary hyperhidrosis that has been inadequately managed with topical agents. The use of BOTOX for treatment of palmar, plantar, or facial hyperhidrosis or for primary axillary hyperhidrosis in the absence of documented medical complications is considered not medically necessary, and is not eligible for coverage. A participating, preferred, or network provider cannot bill the member for the denied service.

Iontophoresis (97033) and axillary liposuction (17999) are considered experimental/ investigational as treatment for primary hyperhidrosis (705.21).  As such, iontophorectic devices used in the home for treatment of primary hyperhidrosis are not covered. The medical efficacy for iontophoresis and axillary liposuction has not been established.  These procedures are not eligible for reimbursement or payment.  A participating, preferred, or network provider can bill the member for these procedures.

Description

Hyperhidrosis is defined as excessive perspiration, beyond a level required to maintain normal body temperature in response to heat exposure, physical exertion, or exercise.  Hyperhidrosis can be classified as either primary or secondary.  Primary hyperhidrosis is idiopathic in nature, typically involving the hands (palmar), feet (plantar), or axillae (underarms).  Secondary hyperhidrosis can result from a variety of drugs,[e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs)], or underlying diseases/conditions, such as febrile diseases, diabetes mellitus, or menopause.  Gustatory hyperhidrosis causes facial hyperhidrosis in response to hot or spicy foods, resulting from surgery to the parotid gland and subsequent aberrant regenerating parasympathetic fibers.

The consequences of hyperhidrosis are primarily psychosocial in nature.  Excessive perspiration may be socially embarrassing (e.g., limiting the ability to shake hands) or interfere with certain professions.  For example, palmar hyperhidrosis may preclude artwork, working with electrical components, or playing certain musical instruments.  In addition, hyperhidrosis may require several changes of clothing daily and may cause staining of clothing and/or shoes.

Treatment of secondary hyperhidrosis (705.22) naturally focuses on treatment of the underlying cause, such as discontinuing certain drugs or providing hormone replacement therapy as a treatment of menopausal symptoms.

NOTE: 
            See Medical Policy Bulletin I-11 for additional guidelines on the use of botulinum toxin.
      

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Under the Federal Employees Program, all services that utilize FDA-approved drugs, devices, or biological products are eligible when intended for the treatment of a serious life-threatening condition and when medically necessary and appropriate for the patient's condition. Iontophoresis, iontophoretic devices and axillary liposuction are considered eligible in the treatment of hyperhidrosis when determined medically necessary based upon the patient's condition.

PRN References

04/2005, Eligibility of treatment for hyperhidrosis is clarified

Treatment of Hyperhidrosis, Medical Policy Reference Manual, Policy 8.01.19, 02/25/04.