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.
First, let's get you the latest codes:
ICD-10 Codes (Effective Oct. 1, 2015)
L74.5 - Focal Hyperhidrosis
L74.51 - Primary Focal Hyperhidrosis
L74.510 - Axilla
L74.511 - Face
L74.512 - Palms
L74.513 - Soles
L74.519 - Unspecified
L74.52 - Secondary Focal Hyperhidrosis
L74.8 - Other Eccrine Sweat Disorders
L74.9 - Eccrine Sweat Disorder Unspecified
Iontophoresis Procedure Codes
97033 - Iontophoresis, each 15 minutes, typically bill for 2-4 units depending on how many areas are treated
99211-99213 - E&M service as applicable
Use -25 modifier if separate identifiable service is rendered
Botulinum Toxin Injection Procedure Codes
64650 - Chemodenervation of eccrine glands, axillae
64653 - Chemodenervation of eccrine glands, other areas (eg, scalp, face, neck), per day
64999 - Unlisted procedure, nervous system(use for extremities, i.e. hands and feet)
J0585 - onabotulinumtoxinA, per unit
The resources listed below provide information, downloadable forms, and support networks to help you work with your patients, their health insurance plans, and even their employer to get the reimbursement you deserve for the vital treatments you provide.
- Hyperhidrosis Health Plan Policies
Your patients' insurance policy may already cover hyperhidrosis treatments. Use this list of popular links to US public hyperhidrosis coverage policies to find out. If you don't see the policy you are researching, see if you can send us the link so we can post it for others.
- Letter of Medical Necessity
Add proof to the case, download this sample Letter of Medical Necessity and submit it to the insurance company as proof that your hyperhidrosis needs treatment.
- Hyperhidrosis Preauthorization Request Form
Similar to the Letter of Medical Necessity, this form should be completed by treating physicians and submitted to the patients' insurance company. It demonstrates that the patient has been diagnosed with hyperhidrosis, lists the treatments that he or she has tried (and that have been unsuccessful), and states the treatment that you are recommending.
If you are seeking reimbursement for treatment with Botox specifically, you may find help through Allergan's extensive and generous support network for physicians and the patients they treat.
- Medical Insurance Statement Form for the Purchase of a Home-Use Iontophoresis Device
Have you prescribed iontophoresis for your patients? They may be able to receive reimbursement for their home-use iontophoresis machine. Download this form and submit it to their health insurer.
- Calculate the cost of hyperhidrosis
This checklist can help patients calculate how much money they spend managing excessive sweat. Plus, their answers to help convince their insurance plan that you deserve reimbursement for treatments, and your patients deserve coverage. Or, if your 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.
- Request Reimbursement
Have you and your patients been denied reimbursement or coverage for hyperhidrosis treatments? You do have recourse. Follow this step-by-step guide to appealing the health plan’s decision.