Botulinum Toxin is a very effective treatment for a select group of patients with migraine.  This select group are the only patients that Medicare provides rebates for.

The Medicare criteria require you to have “experienced an inadequate response, intolerance or contraindication to at least 3 prophylactic migraine medications before commencement of treatment with botulinum toxin, as manifested by an average of 15 or more headache days per month, with at least 8 days of migraine, over a period of at least 6 months, before commencement of treatment with botulinum toxin”

Eligibility Details: http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=18377&qt=ItemID

COST:

If eligible for migraine treatment the total cost is $290.00, you will receive a Medicare rebate of $109.45.  This is charged in addition to your consultation fee.

You will be invoiced directly from Epic Pharmacy ($41.30) to pay for the Botulinum Toxin, this will be mailed to you in the weeks after the treatment has been completed.

If you are NOT Medicare-eligible the cost is significantly higher around $1200.00 for the Botulinum Toxin instead of $41.30 and there is no procedural fee rebate.  It would be better to see the Neurologist for a consultation/assessment first to determine what options are available for you.

Regarding consultation fee, if you have not already been started on Medicare-subsidised Botulinum Toxin by a previous neurologist before having your initial consultation, it is rare to be approved and to receive the product during that initial consultation.

Below is an overview of the different consultation fees:

Standard Initial consult (item code: 110)           Cost: $375.00      Medicare Rebate: $134.30

Complex Initial consult (item code: 132)            Cost: $475.00       Medicare Rebate: $234.85

Standard Follow-up consult (item code: 116)    Cost: $165.00       Medicare Rebate: $67.20

Complex Follow-up consult (item code: 133)     Cost: $215.00       Medicare Rebate: $117.60

Note: The out-of-pocket costs are the same, irrespective of whether your consultation is determined to be Complex or Standard.

If you have any questions or concerns, please contact us on 02 9331 7546.