Insurance coverage for scalp cooling is not yet standard in the United States, but there have been some successful claims.
Success with reimbursement varies depending on health plan, beneficiary coverage, and geographic location. Paxman is currently engaged with a reimbursement consulting organization to assess insurance coverage for scalp cooling technologies.
The NCCN Guidelines now recommend scalp cooling as a category 2A treatment option for patients with invasive breast cancer. This is an important step toward increasing patient and provider access to scalp cooling, as the majority of public and private payers recognize NCCN Guidelines® as the gold standard for coverage and reimbursement policies in the US.
For more information view our 5 Steps to Reimbursement Guide:
1. Obtain and complete the insurance reimbursement claim form from the insurer.
4. Ask your doctor for progress notes. Referencing the use of scalp cooling should be included in your submission.
6. Please note that health insurance coverage varies among individual health plans and may be dependent on policy coverage, location, and other factors stipulated by the health insurance provider. Depending upon health benefit design, each patient may be responsible for a portion of the scalp cooling cost.
You may find the following CPT codes useful when applying for reimbursement:
0662T: Scalp cooling mechanical; initial measurement and calibration of cap. This code is billed when the cap is fitted to each patient and may only be utilized one time per patient.
0663T: Placement of device, monitoring, and removal of device. This code is billed each time the patient receives scalp cooling during chemotherapy and is to be used in conjunction with chemotherapy administration codes 96409, 96411, 96413, 96415, 96416, and 96417.
This information is provided as a convenience by Paxman US, and its content does not and is not intended to constitute legal, billing, coding or compliance advice. Paxman is a product manufacturer and cannot guarantee payment by your insurer, nor can Paxman submit claims to insurance companies. Insurers should contact the patient’s scalp cooling treatment provider to verify applicable codes and treatment services provided, and with any other questions.
Please note that Paxman does not have an NPI (National Provider Identification) number.
Provider Bills Patient Insurance
Some providers are contracted with Paxman to bill your insurance company directly. Ask your provider if they are.
If they aren’t or are unsure, have them contact us here.
Here are providers who offer scalp cooling:
“During chemo your body goes through so many changes and preserving your own hair is not for selfish cosmetic reasons, but about maintaining your sense of self and what little control you have left over your body. I have been fortunate to have great success with Paxman. After multiple appeals, I was able to successfully get 100% reimbursement from my insurance company and I strongly advocate for the standardization of its use.”
If you have had success with insurance reimbursement, we would be delighted to hear about it. We hope that sharing your story could help others to be successful too.
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