Why
Publication 502 says cosmetic surgery generally doesn't count. That includes procedures directed at improving appearance that don't meaningfully promote the proper function of the body or prevent or treat illness or disease. The exception is cosmetic surgery needed to improve a deformity from a congenital abnormality, an accident or a disfiguring disease.
Botox isn't named, so its purpose decides the answer. Treatment a doctor prescribes for a diagnosed condition is medical care. The same injection to smooth forehead lines is cosmetic.
What to keep
- The provider's bill showing the diagnosis, not just the product.
- Your insurer's explanation of benefits, if it was submitted.
Watch out for
- The same split applies to fillers and laser skin treatments.
If you plan to reimburse yourself later
IRS Notice 2004-50, Q&A 39, sets no deadline, as long as the expense came after your HSA was established and your records show it wasn't paid by another source or deducted on a tax return. See what records the IRS expects and how long to keep them.