Medicare Part B may cover Botox if a doctor deems it necessary to treat a specific medical condition.

Botox is a drug that affects muscle contraction. It may be useful for people with health problems such as chronic migraine, overactive bladders, and extreme underarm sweating.

Medicare is a government program that provides healthcare coverage to United States citizens. Beneficiaries are usually ages 65 and above or younger if the person has a certain illness or disability.

This article discusses Medicare coverage for Botox. It also looks at the costs and medical uses of Botox.

Glossary of Medicare terms

We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
  • Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
  • Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
  • Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
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Medicare will not cover the cost of Botox treatments for cosmetic purposes.

However, if the Food and Drug Administration (FDA) has approved Botox for a particular medical treatment, Medicare will usually help cover the cost.

If a doctor prescribes Botox for medically necessary reasons, the individual will receive the treatment as an outpatient medical procedure. Injectable outpatient procedures have coverage from Original Medicare Part B.

FDA approval, and therefore Medicare coverage, includes the following procedures in adults:

In addition, Botox also has FDA approval for use in children ages 2 years or older for upper limb spasticity. It also has FDA approval for treating crossed eyes for a child who is 12 years or older.

According to the American Society of Plastic Surgeons, the average cost of a Botox injection is $528.

The American Migraine Foundation states that the FDA-recommended dosage of 155 units of Botox to treat chronic migraine would cost between $300 and $600 for each treatment.

The cost of Botox treatments can depend on factors such as:

  • the specific Medicare plan
  • the medical condition
  • the number of injections
  • size of the treatment area
  • geographic location

Other costs may include anesthesia, surgery center fees, and prescription medications, such as pain relief or numbing cream.

Medicare Part B may help cover up to 80% of the cost of Botox treatments if a doctor deems them medically necessary. A person may need to pay the remaining 20% as an out-of-pocket cost.

A person also needs to meet their Part B deductible, which is $240 in 2024.

Insurance may pay for medically necessary Botox if a person has Medicare Part B or a Medicare Advantage plan.

Advantage plans include Parts A and B, plus other benefits such as prescription drug, dental, vision, and hearing coverage.

For Medicare Part B, people must pay a monthly premium. In 2024, the standard premium is $174.70 per month.

Medicare beneficiaries also must pay out-of-pocket costs, including deductibles, coinsurance, and copays, for covered treatments and services.

Botox derives from the Botulinum toxin, which the bacterium Clostridium botulinum produces. Botox can weaken or paralyze muscles and is the same toxin that causes botulism.

Botox has Food and Drug Administration (FDA) approval to treat some health conditions such as:

  • excessive underarm sweating
  • chronic migraine
  • strabismus
  • overactive bladder
  • cervical dystonia

There are seven types of botulinum toxin, though types A and B are the most common types for medical usage. Examples include:

  • onabotulinumtoxin A (Botox)
  • abobotulinumtoxin A (Dysport)
  • incobotulinumtoxin A (Xeomin)
  • prabotulinumtoxin A (Jeuveau)

Botox is a registered trademark, though people frequently use the word to describe any botulinum toxin product.

Learn more about the medical and cosmetic uses of Botox.

Below are answers to common questions about Botox.

Does Medicare require prior authorization for Botox?

Medicare requires prior authorization for botulinum toxin injections, including Botox.

Does insurance cover Botox for wrinkles?

Medicare insurance does not cover Botox for wrinkles, as it does not provide coverage for Botox for cosmetic reasons.

Does Medicare pay for Botox injections for migraine?

Medicare may help cover the cost of Botox injections for chronic migraine.

Medicare may help cover the costs of Botox if it is medically necessary. It has approval from the Food and Drug Administration (FDA) for conditions such as chronic migraine, strabismus, overactive bladder, cervical dystonia, and excessive underarm sweating.

If a doctor approves Botox to treat a medical condition, Medicare Part B may help cover the procedure.

The exact cost of Botox treatments can depend on factors such as a person’s Medicare plan, health condition, and geographical location. A person can contact Medicare to find out more about what coverage they may offer for Botox.