Does 11451 require prior authorization?

No, 11451 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 11451?

Medicare facility rate: $319.98. Non-facility rate: $574.16. Work RVU: 4.32.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

4.32

Facility

$319.98

Non-Facility

$574.16

For topical GT (glycopyrronium tosylate) trials and clinical use evidence: documentation consistent with trials—primary axillary hyperhidrosis for ≥6 months, gravimetrically measured sweat production ≥50 mg/5 min in each axilla, ASDD Item 2 (sweating severity) score ≥4, and HDSS score ≥3.
For microwave device RCT inclusion example: HDSS score of 3 or 4 and baseline sweat production greater than 50 mg/5 min (documented gravimetric measurement).
Objective measures sometimes used/recommended in studies: gravimetric sweat measurement (mg/5 min), starch-iodine (Minor's) test, and validated patient-reported outcome scores (e.g., HDSS, ASDD, DLQI).
Patients being considered for sympathectomy should be evaluated by a surgeon and a dermatologist and be well informed and willing to accept surgical risks and the significant risk of compensatory sweating.

CPT codes covered if selection criteria are met: 32664 Thoracoscopy, surgical; with thoracic sympathectomy
CPT codes covered if selection criteria are met: 64650 Chemodenervation of eccrine glands; both axillae
Surgical treatments for primary hyperhidrosis (axillae, palms, or soles) are considered medically necessary for members who are unresponsive or unable to tolerate oral pharmacotherapy prescribed for excessive sweating (e.g., anticholinergics, beta-blockers, or benzodiazepines), and significant disruption of professional and/or social life has occurred because of excessive sweating, and topical aluminum chloride or other extra-strength antiperspirants are ineffective or result in a severe rash, a [...]
Topical Glycopyrronium Tosylate (Qbrexza) — see Pharmacy CPB on Qbrexza.
For generalized hyperhidrosis: investigate and treat underlying cause first; if symptoms persist, systemic medications can be used to reduce sweating
Microwave (microwave-based device / microwave thermolysis) demonstrated effectiveness for treatment of primary axillary hyperhidrosis in clinical trials

AMBETTER-CP.MP.62 — Hyperhidrosis Treatments

CIGNA-0037 — Hyperhidrosis: Surgical Treatments - (0037)

AETNA-CPB-0504 — Hyperhydrosis

REGENCE-SUR165 — Surgical Treatments for Hyperhidrosis

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