64823
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
10.67
Facility
$740.16
Non-Facility
$740.16
Documentation Required
- 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.
Key Coverage Criteria
- 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
1 Active Policy
AETNA-CPB-0504 — Hyperhydrosis
Related Codes
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