Does Bluecross Blueshield Cover Botox Injections

Does Bluecross Blueshield Cover Botox Injections

Bluecross Blueshield Association is a health insurance provider which has been in existence for more than 75 years. They have been putting a lot of efforts to improve quality of health care and coverage. Medical policy No. dru006 is available for Botox Type-A injection.

Generally all contracts need approval for Botox Type-A prior to coverage. For patients with functional impairment due to spasticity or for conditions of involuntary muscle contraction due to several conditions, if it is determined medically that Botox Type-A is needed, then this policy provides coverage.

The conditions for which medically, it is found necessary is based on evidence supported by controlled trials. As many as 21 different conditions associated with spasticity get covered under this category. Botox Type-A is authorized in quantities up to 4 injection treatment within 12 month period for this category of ailments.

There is a second category of conditions, where generally accepted treatments are not effective and or not tolerated for which this policy provides coverage. Conditions such as anal fissures, Achalasia/Cardiospasm, Hyperhidrosis and Incontinence due to detrusor over activity  find mention in this category. In these cases initial authorization of Botox Type-A is up to 2 injection treatments within a 6 months period. If clinical benefit from treatment is confirmed, then up to 4 injection treatments over a 12 month period gets authorized.

Botox Type-A injection is not considered as medically necessary for skin wrinkles and other cosmetic indications. Hence, this policy does not provide coverage. There are further 20 conditions listed which are investigational in nature and hence these conditions also do not get covered under this policy.

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Does Bluecross Blueshield Cover Botox Injections