Treatment of primary focal hyperhidrosis using aluminum chloride 20% solution, botulinum toxin for severe primary axillary hyperhidrosis inadequately managed with topical agents, in individuals ≥18 y, OR Endoscopic Transthoracic Sympathectomy (ETS) and surgical excision of axillary sweat glands, if conservative treatment (ie, aluminum chloride or botulinum toxin, individually and in combination) has failed may be considered medically necessary with any of the following medical conditions:
acrocyanosis of the hands; or
history of recurrent skin maceration with bacterial or fungal infections; or
history of recurrent secondary infections; or
history of persistent eczematous dermatitis despite medical treatments with topical dermatologic or systemic anticholinergic agents.
Treatment of hyperhidrosis is considered investigational in the absence of functional impairment or any of the above medical conditions.
The following treatments may be considered medically necessary for the treatment of severe secondary gustatory hyperhidrosis:
aluminum chloride 20% solution
surgical options (ie, tympanic neurectomy) if conservative treatment has failed.
Other treatments are considered investigational as a treatment for severe secondary gustatory hyperhidrosis including, but not limited to:
botulinum toxin
iontophoresis.
Treatments that may be considered medically necessary by focal region include:
Axillary
Aluminum chloride 20% solution
Botulinum toxin for severe primary axillary hyperhidrosis inadequately managed with topical agents, in individuals ≥18 y
ETS and surgical excision of axillary sweat glands, if conservative treatment (ie, aluminum chloride or botulinum toxin, individually and in combination) has failed;
Palmar
Aluminum chloride 20% solution
Botulinum toxin type A products for severe primary palmar hyperhidrosis inadequately managed with topical agents, in individuals ≥18 y
ETS, if conservative treatment (ie, aluminum chloride or botulinum toxin type A, individually and in combination) has failed;
Plantar
Aluminum chloride 20% solution
Craniofacial
Aluminum chloride 20% solution
ETS, if conservative treatment (ie, aluminum chloride) has failed.
Treatments that are considered investigational by focal region include:
Axillary
Axillary liposuction
Iontophoresis
Microwave treatment
Radiofrequency ablation;
Palmer
RimabotulinumtoxinB
Iontophoresis
Microwave treatment
Radiofrequency ablation;
Plantar
Botulinum toxin
Iontophoresis
Lumbar sympathectomy
Microwave treatment
Radiofrequency ablation;
Craniofacial
Botulinum toxin
Iontophoresis
Microwave treatment
Radiofrequency ablation.
