Hyperhidrosis is the secretion of sweat in amounts greater than physiologically needed for thermoregulation.

It is most commonly a chronic idiopathic (primary) condition; however, secondary medical conditions or medications should be excluded.

Treatment for primary focal hyperhidrosis may be considered medically necessary when any ONE of the following criteria have been met:

• Acrocyanosis of the hands; or
• History of recurrent skin maceration with bacterial or fungal infections, (including but not limited to cutaneous disorders such as dermatophytosis (ringworm), pitted keratolysis, viral warts at the sites of hyperhidrosis); or
• History of atopic dermatitis (atopic eczema) in spite of medical treatments with topical dermatological or systemic anticholinergic agents; and

BOTH of the following criteria must be met:

• Unresponsive to or unable to tolerate pharmacotherapy modalities prescribed for excessive sweating (including but not limited to anti-cholinergics, beta-blockers, or benzodiazepines); and
• Topical 20% aluminum chloride or other extra strength antiperspirants are ineffective or result in a severe rash.

Treatment of Hyperhidrosis not meeting the criterial above will be considered not medically necessary. 

Any ONE of the following treatments may be considered medically necessary for the corresponding focal region ONLY when the general criteria outlined above have been met.

 Axillary Region

• Botulinum toxin A (OnabotulinumtoxinA) for severe primary axillary hyperhidrosis that is inadequately managed with topical agents, in individuals 18 years and older; or
• Iontophoresis; or
• Endoscopic transthoracic sympathectomy (ETS) and surgical excision of axillary sweat glands, if conservative treatment (i.e., aluminum chloride or botulinum toxin, individually and in combination) has failed. 

NOTE: Sympathectomy for hyperhidrosis treatment of axillary and palmar regions requires an inpatient stay. 

Initial authorization for botulinum toxin A (OnabotulinumtoxinA) for axillary hyperhidrosis will expire in 3 months from the original authorization date for any diagnosis. Additional authorization may be given if documentation of an objective measurable effect is provided indicating clinical improvement of the condition. Absence of clinical improvement of axillary hyperhidrosis will be considered not medically necessary for further injections of botulinum toxin A (OnabotulinumtoxinA).

Axillary liposuction, radiofrequency ablation and microwave treatment for axillary hyperhidrosis are considered experimental/investigational and therefore non-coveredbecause the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Treatment of axillary hyperhidrosis not meeting the criteria above will be considered not medically necessary.

Any ONE of the following treatments may be considered medically necessary for the corresponding focal region ONLY when the general criteria outlined above have been met.

Palmar Region

• Botulinum toxin A (OnabotulinumtoxinA) for severe primary palmar hyperhidrosis that is inadequately managed with topical agents, in individuals 18 years and older; or
  
  NOTE: Injections should occur no sooner than 6 months apart.
• Iontophoresis; or
• ETS, if conservative treatment (i.e., aluminum chloride or botulinum toxin type A, individually and in combination) has failed. 

Botulinum toxin B (RimabotulinumtoxinB), microwave treatment and radiofrequency ablation for palmar hyperhidrosis are considered experimental/investigational, and therefore non-coverbecause the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Treatment of palmar hyperhidrosis not meeting the criterial above will be considered not medically necessary.

Any ONE of the following treatments may be considered medically necessary for the corresponding focal region ONLY when the general criteria outlined above have been met.

Plantar Region

• Iontophoresis.

Botulinum toxin, lumbar sympathectomy, radiofrequency ablation, and microwave treatment for plantar hyperhidrosis are considered experimental/investigational because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Treatment of plantar hyperhidrosis not meeting the criterial above will be considered not medically necessary.

Any ONE of the following treatments may be considered medically necessary for the corresponding focal region ONLY when the general criteria outlined above have been met.

Craniofacial Region

• ETS, if conservative treatment (e.g., aluminum chloride) has failed. 

Botulinum toxin, iontophoresis, radiofrequency ablation and microwave treatment for craniofacial hyperhidrosis are considered experimental/investigational, and therefore non-coverebecause the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Treatment of craniofacial hyperhidrosis not meeting the criterial above will be considered not medically necessary.

Secondary Hyperhidrosis: Secondary Gustatory Hyperhidrosis

The following treatment may be considered medically necessary for severe gustatory hyperhidrosis when the above general criteria have been met:

• Surgical options (e.g., tympanic neurectomy, if conservative treatment has failed.) 

Botulinum toxin and iontophoresis for severe gustatory hyperhidrosis are considered experimental/investigational, and therefore non- covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Treatment of secondary hyperhidrosis not meeting the criterial above will be considered not medically necessary.