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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyUniversity Health Alliance hyperhidrosis coverage …
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    CurrentUniversity Health Alliance (HSA)Policy MPP-0053-120301

    Treatment of hyperhidrosis (thoracic sympathectomy and related therapies)

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    This payment policy governs reimbursement and medical necessity criteria for treatments of primary and secondary hyperhidrosis, including thoracic sympathectomy, and applies to providers and members covered by University Health Alliance (UHA).

    Policy Summary
    PayerUniversity Health Alliance (HSA)
    PolicyTreatment of hyperhidrosis (thoracic sympathectomy and related therapies)
    Policy CodePolicy MPP-0053-120301
    Change TypeNo material change
    Effective DateAug 1, 2022
    Last ReviewAug 1, 2022
    Next Review DateN/A
    Key ActionPrior authorization is required and approvals are limited to thoracoscopy with thoracic sympathectomy performed in the ASC setting.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    prior authorization requiredadministrative requirement
    ETS coveredETS coverage

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    multiple not covered
    listed exclusions
    4 weeksminimum trial

    Coverage Criteria for Hyperhidrosis Treatments

    Coverage criteria for hyperhidrosis treatments

    Covered when ALL of the following are met:

    ALL of the following

    • ALL of the following

      • Severe primary focal hyperhidrosis (hyperhidrosis disease severity scale 3 or 4)

        Severity scale defined in policy

      • AND one of the following must be present

        • Documented history of debilitating hyperhidrosis that prevents essential activities of daily living and employment

        • OR one of the medical complications

          • Acrocyanosis of the hands
          • History of recurrent skin maceration with bacterial or fungal infections
          • History of recurrent secondary infections
          • History of persistent eczematous dermatitis despite topical or systemic anticholinergic agents

    • ALL of the following

      • ALL of the following

        • Trial of aluminum chloride 20% solution
        • Botulinum toxin for severe primary axillary hyperhidrosis in patients >= 18 years when inadequately managed with topical agents
        • Endoscopic transthoracic sympathectomy (ETS) or surgical excision of axillary sweat glands when conservative treatments (above individually and in combination) have failed

      • ALL of the following

        • Trial of aluminum chloride 20% solution

      • ALL of the following

    • ALL of the following

      • Trial of aluminum chloride 20% solution
      • Surgical options (e.g., tympanic neurectomy) if conservative treatment has failed

        Applies to secondary gustatory hyperhidrosis

    • ALL of the following

      • When indicated, products must have been tried for a minimum of four weeks
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    title": "Coverage criteria for hyperhidrosis treatments

    Procedure Coding and Administrative Requirements

    surgical procedure codeCPTCovered
    32664Thoracoscopy, surgical; with thoracic sympathectomy
    Minimum trial duration
    Minimum trial4 weeks
    When applicableProducts must have been tried for a minimum of four weeks before surgical options are considered
    ContextApplies when indicated as part of conservative management for hyperhidrosis

    Prior Authorization and Approved Setting

    Prior Authorization

    Prior authorization required; approval limited to thoracoscopy with thoracic sympathectomy in ASC

    Prior authorization is required for hyperhidrosis surgical treatment; requests must be submitted via UHA's online portal (or contact UHA at 808-532-4000 to establish login). If prior authorization is granted, approval is limited to thoracoscopy with thoracic sympathectomy performed in the ASC setting.

    • Submit prior authorization requests through UHA's online portal or use the contact number 808-532-4000 to establish portal access.
    • Approved procedure when authorized: thoracoscopy with thoracic sympathectomy (CPT 32664) performed in the ambulatory surgical center (ASC) setting.

    Definitions and Severity Scale

    Severity scale (1–4)
    Scale range1–4
    3My underarm sweating is barely tolerable and frequently interferes with my daily activities.
    4My underarm sweating is intolerable and always interferes with my daily activities.
    Policy Summary
    PayerUniversity Health Alliance (HSA)
    PolicyTreatment of hyperhidrosis (thoracic sympathectomy and related therapies)
    Policy CodePolicy MPP-0053-120301
    Change TypeNo material change
    Effective DateAug 1, 2022
    Last ReviewAug 1, 2022
    Next Review DateN/A
    Key ActionPrior authorization is required and approvals are limited to thoracoscopy with thoracic sympathectomy performed in the ASC setting.
    SourceLink
    On This Page
    Coverage Criteria for Hyperhidrosis TreatmentsProcedure Coding and Administrative RequirementsPrior Authorization and Approved SettingDefinitions and Severity Scale
    Trial of aluminum chloride 20% solution
  1. Endoscopic transthoracic sympathectomy (ETS) when conservative treatments (above individually and in combination) have failed