Clinical Policy: Hyperhidrosis Treatments Form

Clinical Policy: Hyperhidrosis Treatments
Reference Number: CP.MP.62
Date of Last Revision: 11/25

[Coding Implications](Coding Implications)
[Revision Log](Revision Log)

See [Important Reminder](Important Reminder) at the end of this policy for important regulatory and legal information.

Description
Hyperhidrosis is defined as excessive sweating beyond a level required to maintain normal body temperature.

Please refer to the following:

• CP.PHAR.230 AbobotulinumtoxinA (Dysport)
• CP.PHAR.232 OnabotulinumtoxinA (Botox)
• CP.PMN.177 Glycopyrronium (Qbrexza)

Policy/Criteria

IV. There is insufficient evidence in the published peer reviewed literature to support all other treatments for hyperhidrosis, including, but not limited to, microwave therapy, or liposuction as the sole method of removing axillary sweat glands.

Background
Hyperhidrosis can be classified as either primary or secondary.¹ Primary focal hyperhidrosis is idiopathic in nature and is defined as excessive sweating induced by sympathetic hyperactivity in selected areas that is not associated with an underlying disease process.² The most common locations are underarms (axillary hyperhidrosis), hands (palmar hyperhidrosis), and feet (plantar hyperhidrosis). Primary focal hyperhidrosis is a condition that is characterized by visible, excessive sweating of at least six months’ duration without apparent cause. Hyperhidrosis can ruin clothing, produce emotional distress, and lead to occupational disability.¹

Secondary hyperhidrosis can result from a variety of drugs, such as tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), or underlying diseases/conditions, such as febrile diseases, diabetes mellitus, or menopause. Secondary hyperhidrosis is usually generalized or craniofacial sweating. Secondary gustatory hyperhidrosis is excessive sweating on ingesting highly spiced foods. This trigeminal reflex typically occurs symmetrically on scalp or face and predominantly over the forehead, lips, and nose. Secondary facial gustatory sweating, in contrast, is usually asymmetrical and occurs independently of the nature of the ingested food. This phenomenon frequently occurs after injury or surgery in the region of the parotid gland.

A variety of therapies have been investigated for primary hyperhidrosis, including topical therapy with aluminum chloride, iontophoresis, intradermal injections of botulinum toxin type A, endoscopic thoracic sympathectomy (ETS), and surgical excision of axillary sweat glands.¹,³,⁴ ETS is an invasive procedure intended to arrest the symptoms of hyperhidrosis and involves interrupting the upper thoracic sympathetic chain through clipping, cauterization, or cutting.¹ ETS is considered a last resort due to potential serious, irreversible compensatory sweating (excessive sweating on large areas of the body or all over), as well as other effects, such as extreme hypotension, arrhythmia, and heat intolerance.⁵ Treatment of secondary

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hyperhidrosis focuses on the treatment of the underlying cause, such as discontinuing certain drugs or hormone replacement therapy as a treatment of menopausal symptoms.

Microwave energy has been proposed for the treatment of primary axillary hyperhidrosis. The miraDry System (Mirimar Labs, Inc) is a Food and Drug Administration (FDA) approved device indicated for treatment of primary axillary hyperhidrosis. It is not indicated for treating hyperhidrosis related to other body areas or generalized hyperhidrosis. According to the National Institute for Health and Care Excellence (NICE), “Current evidence on the safety and efficacy of transcatheter microwave ablation for severe primary axillary hyperhidrosis is inadequate in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research. NICE encourages further research into transcatheter microwave ablation for severe primary axillary hyperhidrosis and may update the guidance on publication of further evidence.”⁶

Coding Implications
This clinical policy references Current Procedural Terminology (CPT®). CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2024, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all inclusive and are included for informational purposes only. Codes referenced in this clinical policy are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the most up to date sources of professional coding guidance prior to the submission of claims for reimbursement of covered services.

• Insufficient evidence in published peer-reviewed literature to support suction assisted liposuction or diathermy as the sole method of removing axillary sweat glands.

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12. Glaser DA, Coleman WP 3rd, Fan LK, et al. A randomized, blinded clinical evaluation of a novel microwave device for treating axillary hyperhidrosis: the dermatologic reduction in underarm perspiration study. Dermatol Surg. 2012;38(2):185 to 191. doi:10.1111/j.1524-4725.2011.02250.x
13. Pariser DM, Hebert AA, Drew J, Quiring J, Gopalan R, Glaser DA. Topical Glycopyrronium Tosylate for the Treatment of Primary Axillary Hyperhidrosis: Patient Reported Outcomes from the ATMOS-1 and ATMOS-2 Phase III Randomized Controlled Trials. Am J Clin Dermatol. 2019;20(1):135 to 145. doi:10.1007/s40257-018-0395-0
14. Glaser DA, Hebert AA, Nast A, et al. Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: Results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials. J Am Acad Dermatol. 2019;80(1):128 to 138.e2. doi:10.1016/j.jaad.2018.07.002
15. Sheikh NK, Dua A. Iontophoresis Analgesic Medications. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 31, 2023. Accessed October 23, 2025.
16. Vannucci F, Araújo JA. Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results. J Thorac Dis. 2017;9(Suppl 3):S178 to S192. doi:10.21037/jtd.2017.04.04
17. Dunlap L, Clifton AV, Stephenson J, et al. Interventions for hyperhidrosis. Cochrane Database of Syst Rev. 2022(2). doi: 10.1002/14651858.CD015135
18. Hong HC, Lupin M, O'Shaughnessy KF. Clinical evaluation of a microwave device for treating axillary hyperhidrosis. Dermatol Surg. 2012;38(5):728 to 735. doi:10.1111/j.1524-4725.2012.02375.x
19. International Hyperhidrosis Society. Brella™ Sweat Control Patch.™ https://www.sweathelp.org/hyperhidrosis-treatments/brella.html. Accessed October 01, 2025.

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20. International Hyperhidrosis Society. Iontophoresis. https://www.sweathelp.org/treatments-hep/iontophoresis.html. Accessed October 01, 2025.
21. Evolving Evidence Review. miraDry microwave therapy (miraDry Inc.) for management of primary axillary hyperhidrosis. Hayes. www.hayesinc.com. Published November 16, 2023. Accessed October 13, 2025.
22. Hsu TH, Chen YT, Tu YK, Li CN. A systematic review of microwave-based therapy for axillary hyperhidrosis. J Cosmet Laser Ther. 2017;19(5):275 to 282. doi:10.1080/14764172.2017.1303168
23. International Hyperhidrosis Society. Sofdra™ Topical Gel for Primary Axillary Hyperhidrosis. https://www.sweathelp.org/hyperhidrosis-treatments/sofdra.html. Accessed October 13, 2025.

Important Reminder
This clinical policy has been developed by appropriately experienced and licensed health care professionals based on a review and consideration of currently available generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by this clinical policy; and other available clinical information. The Health Plan makes no representations and accepts no liability with respect to the content of any external information used or relied upon in developing this clinical policy. This clinical policy is consistent with standards of medical practice current at the time that this clinical policy is approved. “Health Plan” means a health plan that has adopted this clinical policy and that is operated or administered, in whole or in part, by Centene Management Company, LLC, or any of such health plan’s affiliates, as applicable.

The purpose of this clinical policy is to provide a guide to medical necessity, which is a component of the guidelines used to assist in making coverage decisions and administering benefits. It does not constitute a contract or guarantee regarding payment or results. Coverage decisions and the administration of benefits are subject to all terms, conditions, exclusions and limitations of the coverage documents (e.g., evidence of coverage, a certificate of coverage, policy, contract of insurance, etc.), as well as to state and federal requirements and applicable Health Plan-level administrative policies and procedures.

This clinical policy is effective as of the date determined by the Health Plan. The date of posting may not be the effective date of this clinical policy. This clinical policy may be subject to applicable legal and regulatory requirements relating to provider notification. If there is a discrepancy between the effective date of this clinical policy and any applicable legal or regulatory requirement, the requirements of law and regulation shall govern. The Health Plan retains the right to change, amend or withdraw this clinical policy, and additional clinical policy may be developed and adopted as needed, at any time.

This clinical policy does not constitute medical advice, medical treatment or medical care. It is not intended to dictate to providers how to practice medicine. Providers are expected to exercise professional medical judgment in providing the most appropriate care, and are solely responsible for the medical advice and treatment of members/enrollees. This clinical policy is not intended to recommend treatment for members/enrollees. Members/enrollees should consult with their treating physician in connection with diagnosis and treatment decisions.

Providers referred to in this clinical policy are independent contractors who exercise independent judgment and over whom the Health Plan has no control or right of control. Providers are not agents or employees of the Health Plan.

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This clinical policy is the property of the Health Plan. Unauthorized copying, use, and distribution of this clinical policy or any information contained herein are strictly prohibited. Providers, members/enrollees and their representatives are bound to the terms and conditions expressed herein through the terms of their contracts. Where no such contract exists, providers, members/enrollees and their representatives agree to be bound by such terms and conditions by providing services to members/enrollees and/or submitting claims for payment for such services.

Note: For Medicaid members/enrollees, when state Medicaid coverage provisions conflict with the coverage provisions in this clinical policy, state Medicaid coverage provisions take precedence. Please refer to the state Medicaid manual for any coverage provisions pertaining to this clinical policy.

Note: For Medicare members/enrollees, to ensure consistency with the Medicare National Coverage Determinations (NCD) and Local Coverage Determinations (LCD), all applicable NCDs LCDs, and Medicare Coverage Articles should be reviewed prior to applying the criteria set forth in this clinical policy. Refer to the CMS website at http://www.cms.gov for additional information.

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