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Coverage criteria policies

Sympathectomy (Thoracic) for the Treatment of Primary Hyperhidrosis

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is required for thoracic sympathectomy.

Coverage

Thoracic Sympathectomy for treatment of primary hyperhidrosis is generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

Thoracic sympathectomy (open or endoscopic) for the treatment of hyperhidrosis is limited to a subset of patients with primary axillary or palmar hyperhidrosis that is intractable and disabling. Intractable and disabling primary axillary or palmar hyperhidrosis is demonstrated when clinical documentation indicates ALL of the following criteria are met:

  1. The condition significantly interferes with the patient’s ability to perform age-appropriate activities of daily living.
  2. The primary hyperhidrosis is causing a chronic dermatological complication such as skin maceration with secondary infection, dermatitis/fungal conditions or other skin diseases.
  3. There is documented failure, contraindication or intolerance to treatment with first or second line medical therapies including:
    1. Topical medications such as prescription aluminum chloride or other extra strength antiperspirants.
    2. Systemic oral medications such as anticholingerics, beta-blockers and benzodiazepines.
    3. Iontophoresis performed in a provider’s office
    4. Treatment with Botulinum Toxin (Botox), Note: Botox is only indicated for use in severe axillary hyperhidrosis and is subject to pharmacy review and prior authorization.

Indications that are not covered

  1. The following treatments or procedures are considered investigational for treatment of hyperhidrosis:
    1. Sympathectomy for craniofacial or plantar hyperhidrosis
    2. Sympathectomy for secondary hyperhidrosis
    3. Tumenescent or ultrasonic liposuction and curettage for axillary hyperhidrosis
    4. Microwave energy therapy (e.g. miraDry)
  2. Sympathectomy is not covered when performed for conditions that are cosmetic in nature, such as excessive spontaneous facial blushing.

Definitions

Activities of Daily Living (ADL’s) refers to a set of common, everyday tasks (as defined by the U.S. Department of Health and Human Services), performance of which are required for personal self-care and independent living; bathing, dressing, eating, toileting and transferring the basic tasks of everyday life, such as eating, bathing, dressing, toileting and transferring.

Thoracic sympathectomy for the treatment of hyperhidrosis involves cutting and sealing a part of the sympathetic nerve chain that is located along the backbone, parallel to the spinal cord. The surgeon may choose one of three approaches: transaxillary, cervical or dorsal

Hyperhidrosis, or excessive sweating, is a medical condition that may be defined as sweating beyond a level that is necessary to maintain normal body temperature as it responds to environmental exposure or exercise. Hyperhidrosis is classified as primary or secondary depending on its cause.

Primary hyperhidrosis (essential or idiopathic) is caused by increased sympathetic nervous system activity, which can lead to excessive sweating. There are several types of primary hyperhidrosis, which affects specific locations of the body: facial sweating (craniofacial), facial blushing (erythrophobia), underarm sweating (axillary), hand sweating (palmar), foot sweating (plantar).

Secondary hyperhidrosis is a symptom of an underlying neurological or systemic disease (i.e. over-active thyroid, low blood sugar, or menopause) which usually affects the whole body. Secondary hyperhidrosis does not involve a malfunctioning sympathetic nervous system

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

CPT Codes

Description

32664

Thoracoscopy, surgical; with thoracic sympathectomy

11450

Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair

15877

Suction assisted lipectomy; trunk

ICD 10 Codes

Description

L74.510

Hyperhidrosis, primary, axilla

L74.512

Hyperhidrosis, primary, palms

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

References

  1. Cerfolio, R., De Campos, J. Bryant, A., Connery, C. , Miller, D. DeCamp, M. McKenna, R. and Krasna, M. (2011) The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis. Annals of Thoracic Surgery, 2011; 91: 1642-1648.
  2. Dickman, C. (2007, Reaffirmed 2009) American Association of Neurosurgeons – Sympathectomy for Hyperhidrosis Position Statement. Retrieved from www.aans.org/en/About-Us
  3. Glaser, D., Coleman, W., Fan, L., Kaminer, M., Kilmer, S., Nossa, R., Smith, S. and O’Shaughnessy, K. (2012) A Randomized, Blinded Clinical Evaluation of a Novel Microwave Device for Treating Axillary Hyperhidrosis: The Dermatologic Reduction in Underarm Perspiration Study. Dermatologic Surgery 2012; 38: 185-191.
  4. Hayes, Inc. Hayes Medical Technology Directory Report. Endoscopic Sympathectomy Treatment of Hyperhidrosis. Lansdale, PA: Hayes, Inc.; January, 2003. Reviewed February, 2008/Archived November, 2008.
  5. Hayes, Inc. Hayes Medical Technology Directory Report. Botulinum Toxin Treatment for Hyperhidrosis. Lansdale, PA: Hayes, Inc.; January, 2008. Reviewed January, 2012/Archived February, 2013.
  6. Hayes, Inc. Hayes Search and Summary Report. Liposuction for Hyperhidrosis. Lansdale, PA. Hayes, Inc. August, 2007.
  7. Hayes, Inc. Hayes Search and Summary Report. miraDry (Miramar Labs Inc) for the Treatment of Hyperhidrosis. Lansdale, PA. Hayes, Inc. April, 2017.
  8. Hong, H., Lupin, M. and O’Shaughnessy, K. (2012) Clinical Evaluation of a Microwave Device for Treating Axillary Hyperhidrosis. Dermatologic Surgery. 38(5): 728-735.
  9. Hoorens I. and Ongenae, K. (2012). Primary focal hyperhidrosis: current treatment options and a step-by-step approach. Journal of the European Academy of Dermatology and Venereology. 26(1): 1-8.
  10. Ibrahim, O., Kakar, R., Bolotin, D., Nodzenski, M., Disphanurat, W., Pace, N., Becker, L...and Alam, M. (2013). The comparative effectiveness of suction-currettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: A randomized control trial Capsule Summary. Journal of the American Academy of Dermatology. 69(1): 88-95.
  11. National Institute for Health and Care Excellence. (2014) Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limb- Interventional Procedures Guidance. Retrieved on 6/15/2017 from https://www.nice.org.uk/guidance
  12. Ram, R., Lowe, N. and Yamauchi, P. (2007) Current and Emerging Therapeutic Modalities for Hyperhidrosis, part 1: Conservative and Non-invasive Treatments. Cutis 2007; 79(3): 211-217.
  13. Ram, R., Lowe, N. and Yamauchi, P. (2007) Current and Emerging Therapeutic Modalities for Hyperhidrosis, part 2: Moderately Invasive and Invasive Procedures. Cutis 2007; 79(4): 281-288.
  14. Reisfeld, R. and Berliner, K. (2008) Evidence-Based Review of the Nonsurgical Management of Hyperhidrosis. Thoracic Surgery Clinics. 18(2): 157-166.
  15. Smith, C. Primary focal hyperhidrosis. In: UpToDate, Dellavalle, R. and Dahl, M. (Ed), UpToDate, Waltham, MA. (Accessed on 5/22/2017).
  16. Sternbach, J. and DeCamp, M. (2016). Targeting the Sympathetic Chain for Primary Hyperhidrosis. Thoracic Surgery Clinics. 26(4): 407-420.

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Policy activity

  • 04/09/2002 - Date of origin
  • 07/01/2017 - Effective date
Review date
  • 05/2017
Revision date
  • 06/19/2017

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