How to Get Botox Covered by Insurance

Though Botox (onabotulinumtoxinA) is often used to relax muscles and temporarily reduce the appearance of wrinkles, it’s also been FDA approved to treat several medical conditions. 

If you suffer from one of those conditions, like chronic migraines or an overactive bladder, you have a better chance of getting your insurance to cover Botox. However, your insurance plan probably won't cover the treatments if you’re contemplating getting Botox to smooth out frown lines or crow’s feet. 

If you need help paying for Botox injections, other options include signing up for a savings program or a patient assistance program and using GoodRx coupons.

Promotion disclosure

credit_cardSponsored copay cardSubject to eligibility

Botox

Avg retail price

$768.39(Save 100.00%)

Copay card

$0

See all discounts

How it works

Use GoodRx to find medications, pharmacies, and discounts.

GoodRx discounts can help you pay less for your prescription.

Bring your free coupon or savings card to the pharmacy.

What medical conditions can Botox be used to treat?

In 1989, the FDA approved Botox as a treatment for blepharospasm and strabismus, two eye muscle disorders. Since then, the medication has been FDA approved to treat 12 medical conditions, including:

• Chronic migraine

• Cervical dystonia

• Overactive bladder

• Adult and pediatric spasticity

• Severe underarm sweating (axillary hyperhidrosis)

• Pediatric detrusor overactivity linked to a neurologic condition

• Incontinence due to an overactive bladder caused by neurologic conditions in adults

Botox can also be used to manage certain types of pain, such as:

• Neck pain

• Pelvic pain

• Myofascial pain

• Neuropathic pain

• Back and sciatica pain

• Joint and osteoarthritis pain

• Jaw and temporomandibular joint (TMJ) pain

Does insurance cover Botox?

If you want to use Botox for cosmetic purposes, your insurance probably won’t cover the injections. However, if your Botox treatments are considered medically necessary, your insurance is more likely to cover them.

If your insurance does cover your Botox treatments, you still may have to pay out-of-pocket costs, such as coinsurance, copayments, or a deductible. The average out-of-pocket expense for Botox for people with commercial insurance is $163 per 12-week treatment. Typically, the effects of Botox last for about 3 to 4 months.

You may also have to meet specific criteria before your insurance will consider covering Botox. For example, the Centers for Medicare & Medicaid Services (CMS) requirements include a qualifying diagnosis and a statement from your healthcare professional that first-choice treatment methods have previously proven unsuccessful. 

EXPERT PICKS: WHAT TO READ NEXT

• How much does Botox cost? It depends on a few factors. Here we break down how much Botox injections could cost you.

• Side effects and safety: Many Botox side effects are mild and temporary. But in rare circumstances, it can present serious side effects. We’ll let you know what you should look out for when getting Botox.

• Protect yourself from counterfeit Botox: Counterfeit versions of Botox have appeared in numerous states. Learn how to spot counterfeit Botox so you can feel secure and confident in your treatment.

• Treatment for migraines, neck spasms, and more: There are several surprising FDA-approved uses for Botox besides reducing wrinkles.

The CMS also requires that your medical records include: 

• Information about the type and dosage of botulinum toxin used, such as Botox or Dysport 

• Description of the injection site(s) targeted during treatment

• Support for the injections’ clinical effectiveness 

• Medical necessity support for any electromyography procedures performed

How to get Botox covered by insurance

The best way to get Botox covered by insurance is to be proactive. Take the following six steps to increase your chances of getting the injections covered:

1. Check your insurance plan details. Review your policy to learn about the requirements for Botox coverage.

2. Talk to your medical team. Discuss Botox with your healthcare professional to find out if they consider the treatments medically necessary.

3. Get a prescription. To ensure Botox is used safely and appropriately, you typically need a prescription from your healthcare professional to get the injections.

4. Ask for a referral. To get Botox, you need to see a licensed professional who knows the appropriate dosages, injection techniques, and side effects associated with the treatments.

5. Get a prior authorization. Your insurance may require a prior authorization before covering Botox. Gather the necessary documentation in advance, in case you need to prove medical necessity to get coverage.

6. Request an appeal. If you’re denied Botox coverage, you usually have 180 days to submit an appeal. When you submit the appeal, include all additional information the insurance provider should consider.

What other coverage options can help pay for Botox?

If you need help paying for Botox, here are some ways to save money on the injections, whether they’re for medical purposes or cosmetic reasons.

You can also look for special pricing on Botox treatments as a way to save. Some medical spas and clinics offer promotions like $10 per unit instead of $13 per unit for new clients receiving Botox.

Another way to save on the cost of treatments is to use your tax-free health savings account (HSA) or flexible spending account (FSA) funds. When you use your HSA or FSA money for medically necessary Botox treatments, you may be required to get a letter of medical necessity (LOMN) and additional documentation to be eligible for reimbursement. 

How much is Botox without insurance?

According to a 2019 report from the American Society of Plastic Surgeons (ASPS), one unit of Botox typically ranges in cost from $10 to $15. An average treatment may involve 30 to 40 units, so the total cost can range from $300 to $600. 

Several factors determine the price of Botox treatments, including:

• Administrator expertise and qualifications 

• Medical condition (if any) being treated

• Amount of insurance coverage

• Size of the treatment area

• Number of units injected

• Number of injections

• Location of the treatment facility

For example, Dr. Cat Plastic Surgery in Beverly Hills, California, charges $25 per Botox unit, while Metropolitan Skin Clinic in Edina, Minnesota, charges $13.50 per unit. 

At Rocky Mountain Laser College in Lakewood, Colorado, average prices are listed according to condition. Botox for jaw clenching and TMJ costs about $480 for 40 units. The average price to treat excessive sweating is around $1,200 for 100 Botox units.

Why trust our experts?

Written by:

Mitzi S. Morris

Mitzi S. Morris is a freelancer who writes long-form content such as blogs, e-books, and white papers. She has a certificate in digital communication from the University of North Carolina at Chapel Hill and a Bachelor of Arts in Communication from Hanover College.

Edited by:

Charlene Rhinehart, CPA

Charlene Rhinehart, CPA, is a personal finance editor at GoodRx. She has been a certified public accountant for over a decade.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Our editorial standards

Meet our experts