CurrentCentenePolicy CP.MP.62

Hyperhidrosis Treatments

Defines medical necessity criteria for iontophoresis (including Drionic device), surgical excision of axillary sweat glands, and endoscopic thoracic sympathectomy (ETS) for primary hyperhidrosis, and states that other treatments (e.g., microwave, liposuction) lack sufficient evidence.

Policy Summary

PayerCentene

PolicyHyperhidrosis Treatments

Policy CodePolicy CP.MP.62

Change TypeMultiple annual revisions (content, coding, criteria updates)

Effective Date

Next Review Date

Key ActionDocument diagnosis, medical complications or significant functional/social disruption, trial and failure of conservative management including adherent application of aluminum chloride hexahydrate or intolerance, and absence of listed contraindications.

POLICY UPDATE CHANGES

Updated criteria I.E.3 by removing parenthetical about pregnancy; added epilepsy to contraindications; removed six-month timeframe for trial of conservative management; removed a note under Criteria III regarding standard line of medical therapy.

Updated Criteria II.B to resting heart rate > 55 beats per minute and clarified II.A and III.A to include through Criteria I.E.

Added criteria point III.I regarding counseling on risks (documented counseling requirement).

Removed CPT codes 64802 through 64823 from coding section and updated referenced CPT list.

Added diathermy to notation in coding section regarding insufficient evidence for certain therapies.

3Procedures with explicit criteria (iontophoresis, surgical excision, ETS)

1Treatments stated as insufficient evidence (e.g., microwave/liposuction)

5Contraindications listed for iontophoresis

Coverage Summary

This policy (Policy Number: CP.MP.62; Status: CURRENT; Last Review: 2025-11-25) defines medical necessity criteria for treatment of primary hyperhidrosis with iontophoresis (including the Drionic device), surgical excision of axillary sweat glands, and endoscopic thoracic sympathectomy (ETS). It specifies required diagnostic, complication/function impact, prior-conservative-therapy, and contraindication criteria for iontophoresis; criteria to qualify for surgical excision (including failure of iontophoresis or botulinum toxin); and physiologic, demographic, clinical, and counseling requirements for ETS. The policy states that other treatments (for example, microwave therapy or liposuction as the sole method of removing axillary sweat glands) lack sufficient evidence and are not supported.

Clinical thresholds

Resting heart rate> 55 beats per minute

Age of symptom onset< 16 years

Age for ETS request< 25 years

Body mass index< 28

Medical Necessity Criteria

I. Iontophoresis (including Drionic device) - Medically Necessary

Covered when ALL of the following are met:

ALL of the following

Diagnosis of primary hyperhidrosis
Development of medical complications (e.g., skin maceration with secondary skin infections) or significant constant disruption of professional and/or social life (e.g., recurrent changing of clothes, affecting job/social function) which has occurred because of excessive sweating
Failed a trial of conservative management including the adherent application of aluminum chloride hexahydrate (Drysol by prescription), or topical agents have resulted in a severe rash
No contraindications

Coding

Surgical & Procedural CPT codes referencedCPT

11450	Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair
11451	Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repair
15877	Suction assisted lipectomy; trunk
15878	Suction assisted lipectomy; upper extremity
32664	Thoracoscopy, surgical; with thoracic sympathectomy
97024	Application of a modality to 1 or more areas; diathermy (eg, microwave)
97033	Application of a modality to 1 or more areas; iontophoresis, each 15 minutes

Surgical & Procedural CPT codes referencedCPT

11450	Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair
11451	Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repair
15877	Suction assisted lipectomy; trunk
15878	Suction assisted lipectomy; upper extremity
32664	Thoracoscopy, surgical; with thoracic sympathectomy
97024	Application of a modality to 1 or more areas; diathermy (eg, microwave)
97033	Application of a modality to 1 or more areas; iontophoresis, each 15 minutes

Provider Actions & Prior Authorization

Prior Authorization

Medical necessity documentation for iontophoresis

Document diagnosis of primary hyperhidrosis, any medical complications or significant functional/social disruption from excessive sweating, a trial and failure of conservative management including adherent application of aluminum chloride hexahydrate (or intolerance such as severe rash), and confirm absence of listed contraindications (cardiac pacemaker, cardiac arrhythmias, pregnancy, metal implants depending on size/position, epilepsy).

97033

Prior Authorization

Medical necessity documentation for surgical excision

Document that the iontophoresis criteria are met (see iontophoresis documentation), that the member has persistent and severe primary hyperhidrosis, and that the member failed iontophoresis or had a trial of botulinum toxin prior to surgical excision.

Background, Evidence & Definitions

Primary focal hyperhidrosis is idiopathic excessive focal sweating—most commonly of the axillae, palms, and soles—and is characterized by visible, excessive sweating (historically at least six months' duration) that can cause clothing damage, emotional distress, and occupational or social impairment. Secondary hyperhidrosis is sweating related to drugs or systemic conditions and is often generalized or craniofacial. Treatment options for primary hyperhidrosis include topical aluminum chloride, iontophoresis, botulinum toxin injections, surgical excision of axillary sweat glands, and ETS; ETS is considered a last-resort invasive procedure because of the risk of potentially serious and irreversible compensatory sweating and other adverse effects.

Source	Summary
NICE guidance	Current evidence on transcutaneous microwave ablation for severe primary axillary hyperhidrosis is inadequate in quantity and quality; should only be used with special arrangements (clinical governance, consent, audit or research).
FDA	miraDry System is FDA-approved for primary axillary hyperhidrosis; however, NICE considered the evidence inadequate.

Primary hyperhidrosis: Idiopathic focal excessive sweating (historical definition: visible, excessive sweating of at least six months' duration without apparent cause).

Revision History

04/13revision

Policy developed and specialist review; combined criteria points in II.H and III.C to read 'failed one of the following: 1. Iontophoresis or 2. Trial of botulinum toxin.' References reviewed and updated.

01/22annual_review

Annual review with references updated; header terminology changed and experimental/investigational verbiage replaced; pharmacy policy cross-references updated; approved 01/22.

01/23annual_review

Annual review; Updated Criteria II.B to resting heart rate > 55 bpm and removed 'is relatively healthy' in II.F; background updated with no impact to criteria; approved 01/23.

Policy Summary

PayerCentene

PolicyHyperhidrosis Treatments

Policy CodePolicy CP.MP.62

Change TypeMultiple annual revisions (content, coding, criteria updates)

Effective Date

Next Review Date

On This Page

Metal implants, depending on size and position (may divert the electric current)

Prior Authorization

Medical necessity documentation for ETS

Document that the iontophoresis criteria are met and that the member satisfies physiologic and demographic thresholds (resting heart rate > 55 beats per minute; symptom onset usually < 16 years; surgery requested usually < 25 years of age; body mass index < 28), reports no sweating during sleep, has no significant comorbidities, has persistent and severe primary hyperhidrosis, has failed iontophoresis or trial of botulinum toxin, and has been counseled on procedural risks.

32664

Documentation Required

Counseling requirement for ETS

Document that the member/enrollee has been counseled on the risks of the ETS procedure.

01/24revision

Annual review with minor rewording of pharmacy title, changed order of criteria, added Criteria III.I requiring counseling on risks, removed CPT codes 64802-64823, and removed then later restored a note regarding standard line of medical therapy; approved 01/24.

03/24correction

Correction added: restored note regarding the normal line of medical therapy after it had been erroneously removed during the January 2024 annual review; approved 03/24.

11/24annual_review

Annual review: updated I.E.3 by removing parenthetical about pregnancy, removed prior I.E.5 about cracked skin, added epilepsy to contraindications, minor grammatical and verbiage updates across criteria, and added diathermy notation in coding section; approved 11/24.

11/25revisionLatest

Annual review culminating in 11/25 approval: removed 'in response to heat exposure or exercise' from description; removed Criteria I.C regarding pharmacotherapy intolerance/unresponsiveness; removed six-month timeframe for trial of conservative management in I.D; removed note under III regarding standard line of medical therapy; coding and descriptions reviewed. Marked as material change.