• FAQ
  • Forms & Insurance
Office (941) 955-5858 Fax (941) 955-0044
HealthFlex
×
  • Home
  • Our Practice
    • About Sarasota Neurology
    • Our Staff
  • Services
  • My Blog
  • Info
    • Patient’s & Visitor’s Guide
    • Appointment Booking
    • Forms & Insurance
    • FAQ
  • Contact
  • Medical Missions

Does Insurance Cover Botox Injections for Migraine Headaches?

March 3, 2015admindanMigraines / HeadacheUncategorized

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, which have been unresponsive to standard preventative therapies. In 2011, the FDA approved Botox for treating chronic migraines which have been unresponsive to an adequate trial of preventative medications. Preventative medications do not include the use of any narcotic pain killers. Insurance companies have made it difficult for patients to obtain Botox payment 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 preventative therapies from the 4 Migraine Prevention drug groups: 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 medical letter documenting all your prior migraine prevention treatment you have received is needed. Additionally, documentation is required for how many migraine days per month you suffer 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 – “rebound headaches.”
  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:
a. Antidepressants: amitriptyline, nortriptyline, fluoxetine, escitalopram, citalopram, venaflaxine.
b. Anticonvulsants: valproic acid, topiramate, gabapentin
c. Antihypertensives: propanolol, nadolol, Verapamil
d. Muscle relaxants: Baclofen, cyclobenzaprine

Continued insurance coverage and payment for Botox injections for 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 session 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.

DrKBotoxLogo

 

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

Search

Recent Posts

  • Nurtec – Novel New Migraine Treatment
  • Aimovig
  • Professional and Olympic Athletes Using Platelet Rich Plasma for Joint Pain and Muscle Injuries
  • Platelet Rich Plasma PRP Therapy in Sarasota Florida for Joint and Foot Pain
  • Does Insurance Cover Botox Injections for Migraine Headaches?

Recent Comments

    Archives

    • July 2020
    • June 2018
    • January 2016
    • May 2015
    • March 2015
    • December 2014
    • November 2014
    • October 2014
    • September 2014
    • August 2014
    • November 2013
    • March 2013
    • May 2012
    • November 2011
    • April 2011
    • March 2011
    • February 2011
    • December 2010
    • October 2010
    • March 2010
    • January 2010
    • October 2009
    • September 2009
    • July 2009
    • October 2008
    • September 2008
    • August 2008
    • July 2008
    • June 2008
    • May 2008
    • April 2008
    • December 2007
    • November 2007
    • October 2007
    • September 2007
    • August 2007
    • April 2007
    • January 2007
    • November 2006
    • October 2006
    • September 2006

    Categories

    • Back Pain
    • Botox
    • Brain Stimulation
    • Computers
    • General Medicine
    • High Cholesterol
    • Memory Loss / Alzheimer's Disease / Dementia
    • Migraines / Headache
    • Movement Disorders
    • Nerve Diseases
    • Nerve Pain
    • Neuropathy
    • Pain
    • Parkinson's disease
    • Platelet Rich Plasma
    • Podcast
    • Seizures
    • Stroke
    • Uncategorized
    • Vertigo / Dizziness
    • Welcome

    Meta

    • Log in
    • Entries feed
    • Comments feed
    • WordPress.org

    logo

    Phone (941) 955-5858 Fax: (941) 955-0044

    info@sarasotaneurology.com

    3501 Cattlemen Rd, Sarasota, FL 34232

    Facebook

    Latest News

    • Nurtec - Novel New Migraine Treatment Jul 2

    • Aimovig Jun 20

    • Professional and Olympic Athletes Using Platelet Rich Plasma for Joint Pain and Muscle Injuries Jan 12

    • Platelet Rich Plasma PRP Therapy in Sarasota Florida for Joint and Foot Pain May 28

    • Does Insurance Cover Botox Injections for Migraine Headaches? Mar 3

    Copyright ©2018 all rights reserved
    Designed by YoHoHosting