Treatment of Hyperhidrosis*Medical Policy: 08.01.08 This policy applies to all products unless specific contract limitations, exclusions or exceptions apply. Please refer to the member's coverage manual for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply. Hyperhydrosis is excessive sweating, beyond a level required to maintain normal body temperature in response to heat exposure or exercise. Hyperhydrosis can be classified as either primary or secondary. Primary hyperhidrosis is idiopathic in nature and typically involves the palmar surface of the hands, plantar surface of the feet, or the axillae. Secondary hyperhidrosis is the result of an underlying condition such as Parkinson's Disease, hyperthyroidism, diabetes mellitus, and hyperpituitarism. Certain drug classifications such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI's) have been known to cause secondary hyperhidrosis. Resolution of secondary hyperhidrosis involves treatment of the underlying cause or condition. Thoracic sympathectomy is an invasive procedure intended to arrest the symptoms of hyperhidrosis. T2 sympathectomy is performed for patients with palmar hyperhidrosis and may significantly reduce foot sweating as well; while T3 and T4 sympathectomies are performed for those with axillary hyperhidrosis. The procedures can be performed with either conventional electrocautery or laser. Treatment of primary axillary, palmer, and plantar hyperhidrosis with botulinum toxin may be considered medically necessary only for patients with a significant functional impairment or medical complication who have failed to respond to conservative treatment. Conservative treatment includes topical dermatologics such as aluminum chloride, tannic acid, glutaraldehyde, anticholinergics or systemic medications such as anticholinergics, tranquilizers or non steroid anti-inflammatory drugs.Treatment of primary hyperhidrosis with surgical excision of the axillary sweat glands may be considered medically necessary for patients who have failed to respond to conservative treatment. Treatment of primary hyperhidrosis with thoracic sympathectomy* may be considered medically necessary when the following is met:
Prior approval is recommended only for thoracic sympathectomy. Submit a prior approval now. Treatment of secondary hyperhidrosis with any of the above-mentioned approaches may be considered medically necessary only when treatment of the underlying cause of the hyperhidrosis has failed to relieve the symptoms and the symptoms continue to be severe and result in significant medical complications. Treatment of primary hyperhidrosis with iontophoresis is considered investigational. Treatment of primary hyperhidrosis with axillary liposuction is considered investigational. Treatment of primary hyperhidrosis with thoracic sympathectomy in patients not meeting the above criteria is considered investigational. Treatment of all forms of hyperhidrosis with any method described above in patients who do not meet the criteria described above is considered investigational. Procedure Codes and Billing Guidelines:
*Prior Approval is recommended for this policy **Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved. Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc. They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice. |
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