Does Insurance Cover Botox Injections for Migraine Headaches?

Does Insurance Cover Botox Injections for Migraine Headaches?

Unfortunately no insurance company covers Botox therapy for generic headaches. Many will cover Botox for chronic migraines, unresponsive to standard therapies. The FDA approved Botox usage, in 2011, for treating chronic migraines which have been unresponsive to an adequate trial of multiple preventative medications. This list does not include the use of any narcotic pain killers. Insurance companies have made it quite difficult for patients to obtain coverage authorization by putting in place numerous qualification barriers – if they cover Botox at all.

Insurance companies do require extensive documentation of treatment with other migraine preventatives from at least 4 other drug classes: 1) anti-hypertensive (blood pressure) medications, 2) anticonvulsants, 3) antidepressants and 4) muscle relaxants – all which must have been tried for a minimum of 30 days and failed each or any combination of the four classes. A letter documenting all your facts regarding the migraine prevention treatment you have received, from your neurologist, is needed. Additionally, documentation is required for how many migraine days per month a patient suffers from.

In summary, this letter from your neurologist must document the following:

1. Adult patient diagnosed with chronic migraine headaches.
2. Having fifteen or more migraine days per month, with the headache lasting over four hours or more.
3. Migraines having been present for over six months. 
4. Headaches are not due to abortive medication overuse.
5. Poor responsiveness to abortive medications, specifically in the triptan class of drugs.
6. Persistent, recurrent migraines despite trials of at least 1 medication in each of the 4 classes of migraine preventative drugs:

Continuing treatment (insurance payment) with Botox injections for ongoing, chronic migraine prevention is considered medically necessary by insurance companies when migraine headache frequency is reduced by 7 headache days or more, per month – as compared to pretreatment with Botox – at the end of the initial therapy treatment AND with documentation of the same with each successive treatment. All of the criteria listed above must be met before each Botox therapy will be approved by insurance or Medicare.

Given the frequency by which insurance companies frequently deny Botox, even after approval, you will be financially responsible for payment of every Botox treatment. Due to the difficulty and time consuming process of getting Botox authorization from the insurance companies, for treatment of chronic migraine, it has become necessary that each patient obtain their own authorization number for each Botox treatment. We will provide you with the required letter, documenting the pertinent facts. You can get assistance with Botox through their Botox Patient Assistance Program Hotline. For more information please click on the link below.

Required codes for Botox migraine therapy: Chronic migraine: 346.71; Botox: J0585;Botox Migraine injection: 64615. You will need authorization for all three codes.