Where does the IRS draw the line?
The line is between appearance and health. IRS Publication 502 defines medical expenses as the costs of diagnosing, treating, mitigating or preventing disease, and costs for the purpose of affecting any part or function of the body. In the same publication, the IRS says you generally cannot include cosmetic surgery, which it defines as any procedure directed at improving appearance that does not meaningfully promote the proper function of the body or prevent or treat illness or disease.
The IRS names face lifts, hair transplants, hair removal and liposuction as examples. Wrinkle relaxers and fillers are not listed by name, but they fall under the same test: their purpose is how you look.
There is one narrow exception. Publication 502 allows cosmetic procedures that are necessary to improve a deformity arising from a congenital abnormality, a personal injury from an accident or trauma, or a disfiguring disease. Smoothing frown lines or sharpening a jawline does not fit that exception.
How does a men’s clinic menu sort out?
Here is how the services at Ultimate Male generally fall, using the appearance test above. Your plan administrator has the final word on any claim.
| Service | Usual status | Why |
|---|---|---|
| BOTOX, XEOMIN or Jeuveau for lines | Not eligible | Purpose is appearance |
| JUVÉDERM, VOLUMA, RADIESSE or Sculptra filler | Not eligible | Purpose is appearance |
| VI Peel or PicoSure Pro for sun spots or melasma | Not eligible | Treats the look of pigment |
| PRP for thinning hair | Generally not eligible | Hair transplants are named as cosmetic, and PRP for hair faces the same appearance test |
| NEO Slim body sculpting | Not eligible | Body contouring for appearance |
| Blood testing panels | Generally eligible | Lab fees that are part of medical care count |
| Testosterone therapy for diagnosed deficiency | Generally eligible | Treats a diagnosed condition |
| Medical weight loss for a diagnosed disease | Generally eligible | Publication 502 includes weight loss that treats a specific disease diagnosed by a physician |
So the same visit can contain both kinds of spending. If you have your labs drawn and a wrinkle relaxer on the same day, the lab work can go on your HSA card and the injection should go on a regular card. Our preventative blood testing page covers the panels that typically qualify.
What about BOTOX used for a medical condition?
The same drug can sit on either side of the line depending on why it is used. Botulinum toxin is also used to treat diagnosed medical conditions, such as severe underarm sweating or chronic migraine, and spending on treatment of a diagnosed condition is analyzed as medical care rather than cosmetic surgery.
That exception does not apply to wrinkle relaxers for lines, which is what the BOTOX, XEOMIN and Jeuveau menu at Ultimate Male covers. If you are being treated elsewhere for a medical use, ask that provider for documentation of the diagnosis before you submit a claim.
What happens if you use HSA money on a cosmetic treatment?
It costs you. According to IRS Publication 969, a distribution from an HSA that is not used for qualified medical expenses is taxable, and there is an additional 20% tax on that portion. The extra 20% does not apply after you become disabled, reach age 65, or die, though the income tax still does.
With an FSA, an ineligible charge is usually caught at the claim stage. The administrator may deny it or ask you to repay the amount, so a swipe that goes through at the front desk is not proof that the expense qualified.
How to pay for cosmetic care at Ultimate Male
Ultimate Male is a direct-pay clinic that does not bill insurance, and prices are not published; you get a quote before you book. You pay per visit with no membership, and you can spread the cost of a series through CareCredit, Prosper Healthcare Lending or Afterpay, which our financing page explains.
For medical services, we provide itemized receipts you can submit to your FSA or HSA. Our broader guide to HSA and FSA eligible treatments covers the medical side of the menu, and our BOTOX for men cost page explains what drives the price of a wrinkle relaxer. When you are ready, explore our aesthetics services or call 626-319-5261.
