How to Get Botox Covered by Insurance

Botox (onabotulinumtoxinA) is often used to relax muscles and temporarily reduce the appearance of wrinkles. But it’s also FDA approved to treat medical conditions, including chronic migraines and an overactive bladder.

If you’re living with one of these conditions, you have a better chance of getting your insurance to cover Botox. But your insurance plan probably won’t cover the treatments if they’re smoothing out frown lines or crow’s feet (called Botox Cosmetic).

If you need help paying for Botox injections, you have a few options. You could sign up for a savings program or a patient assistance program or use GoodRx coupons.

Which 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. Today the medication is used to treat several FDA-approved medical conditions, including:

• Chronic migraine

• Cervical dystonia (a condition that causes neck spasms)

• Overactive bladder

• Adult and pediatric spasticity (stiff, tight muscles)

• Severe underarm sweating (axillary hyperhidrosis)

• Pediatric detrusor overactivity (a type of overactive bladder in kids) linked to a neurological condition

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

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

• Neck pain

• Pelvic pain

• Myofascial pain

• Neuropathic (nerve) pain

• Back and sciatica pain

• Joint and osteoarthritis pain

• Jaw and temporomandibular joint (TMJ) pain

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Keep in mind that Botox isn’t approved to manage these conditions. But healthcare professionals may prescribe it off-label for them.

Does insurance cover Botox?

It depends on the reason you’re using it. If your Botox treatments are considered medically necessary, your insurance is more likely to cover them. But if you want to use Botox for cosmetic purposes, your insurance likely won’t cover the injections. This includes cosmetic procedures such as: 

• Trap Botox (“Traptox”) for slimming the shoulders and neck

• Under-eye botox to reduce the appearance of fine lines

• Masseter Botox for jawline contouring

• Forehead Botox to smooth horizontal lines

• Crow’s feet Botox to soften lines at the outer corners of the eyes

These treatments are considered elective and are typically not covered by insurance.

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. On average, the out-of-pocket expense for Botox for people with commercial insurance is $163 for 12 weeks. Typically, the effects of Botox last about 3 to 4 months, but they may last longer for certain conditions.

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

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CMS also requires that your medical records include:

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

• Description of the targeted injection sites

• Support for the injections’ clinical effectiveness

• Medical necessity support for 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 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 a healthcare professional to find out if it’s medically necessary.

3. Get a prescription. To ensure Botox is used safely and appropriately, you’ll need a prescription from your healthcare professional.

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 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 (6 months) to submit an appeal. When you submit the appeal, include all 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. These can be used if the treatments are 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 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 and additional documentation to be eligible for reimbursement. Botox Cosmetic is not HSA or FSA eligible.

How much does Botox cost without insurance?

According to a 2019 American Society of Plastic Surgeons report, one unit of Botox is typically $10 to $15. Treatment involves 30 to 40 units on average, so the total cost could be $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. But Metropolitan Skin Clinic in Edina, Minnesota, charges $13.50 per unit.

Rocky Mountain Laser College in Lakewood, Colorado, charges $12 per unit. But they inject different amounts of units depending on why you’re receiving Botox. So your total cost would vary depending on your condition or cosmetic use. For instance, Botox for jaw clenching and TMJ costs about $480 for 40 units. The average price to treat excessive sweating is about $1,200 for 100 Botox units.

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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:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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