Medicare and other insurance companies will not pay for cosmetic Botox injections but will cover Botox as a medical treatment.

Botulinum toxin, commonly known as Botox, is an injectable solution that has been in use since 1987.

Botox is commonly used to reduce the appearance of fine lines and wrinkles, but its muscle-relaxing effects can also help treat a handful of medical conditions.

Original Medicare (parts A and B) covers only procedures and treatments that are considered medically necessary. A procedure is considered medically necessary when it’s used to help prevent or treat a health condition.

The same rules apply if you have Medicare Advantage (Part C). Although Medicare Advantage plans often cover additional services — like vision, dental, or prescription drugs — they do not include cosmetic or elective therapies.

Medicare will cover Botox injections if your doctor orders them to treat an approved condition. This may include:

  • Migraine: Migraine episodes often take the form of chronic, severe headaches that can last for hours or even days.
  • Severe neck (and other muscle) spasms: A muscle spasm is an involuntary, often painful twitching in the neck, arms, legs, or eyes.
  • Overactive bladder: This causes a frequent and urgent need to urinate and can lead to incontinence.
  • Overactive sweat glands: When your body produces too much perspiration (sweat), your sweat glands are considered overactive. This can lead to dehydration and difficulty maintaining proper hygiene.
  • Crossed eyes: This can prevent your pupils from properly focusing, resulting in pain and difficulty seeing.
  • Temporomandibular joint (TMJ) disorder: TMJ disorders cause your jaw to click or lock, leading to pain and difficulty eating.

You can take a few steps to increase the chances that Medicare will cover your Botox procedure, though there’s no guarantee you’ll get approval.

You might:

  • Ask your Medicare-approved doctor to submit a request to Medicare: The request should detail why Botox is medically necessary to treat your condition.
  • Send records of your condition to Medicare: Gather and send as many records about your condition and other treatments you’ve tried. For example, if you’ve tried several prescription drugs to treat migraine and they haven’t worked, you should send Medicare those records. Your doctor might be able to provide the records if you don’t have them.
  • Contact Medicare: You can contact Medicare directly by calling 800-MEDICARE (800-633-4227). Explain your condition and see if you’re eligible for coverage. The Medicare representative might be able to tell you whether you should send in any specific documents or take any additional steps.

The steps for getting coverage might differ depending on why you need Botox. For example, if you need Botox for migraine, Medicare will need to see proof of the following:

  • a diagnosis of chronic migraine
  • documented symptoms of chronic migraine
  • documentation that at least two other forms of treatment have not helped

Your doctor can help you determine the documentation you need. If you’re still unsure, call Medicare and follow the steps the representative provides.

You can still get Botox injections if Medicare denies coverage. However, you’ll need to pay for 100% of the cost out of pocket or look into a savings program. This is true no matter what kind of Medicare coverage you have.

Your overall cost will depend on the number of sessions you need and how much of the drug is required during each session.

If Medicare denies your coverage and you decide not to get Botox, you may have other options. Consult with your healthcare professional to learn more.

Alternatives to Botox for migraine

Your doctor might recommend new medications or a combination of medications to treat chronic migraine.

For example, many people are helped by taking a combination of antidepressants and nonsteroidal anti-inflammatory (NSAID) medications.

Medicare Part D will cover most of the prescription drugs you’d need in these categories.

Alternatives to Botox for muscle spasms

A doctor might prescribe a muscle-relaxing medication to help with your neck or other muscle spasms. If so, Medicare Part D will cover your prescription.

Alternatives to Botox for overactive bladder

Medications that relax your bladder can provide relief from an overactive bladder. You can get coverage for these prescriptions through Medicare Part D.

Alternatives to Botox for overactive sweat glands

A prescription antiperspirant can help treat overactive sweat glands. Medicare Part D covers many prescription antiperspirants.

Alternatives to Botox for crossed eyes

Eye drops can help treat crossed eyes. You might receive these eye drops in your doctor’s office or have a prescription you use at home.

Drops given by your doctor are covered under Medicare Part B, while drops you use at home are covered under Medicare Part D.

Alternatives to Botox for TMJ disorders

NSAIDs can help with the pain of TMJ disorders. You can get coverage for prescription NSAIDs under Medicare Part D.

Medicare won’t cover Botox when it’s used for cosmetic reasons.

But Botox has been approved as a treatment for multiple medical conditions, and Medicare does offer coverage for medically necessary Botox.

You can look into alternative treatment options if Medicare denies your claim for coverage of Botox.