Insurance
Reimbursement
Insurance Reimbursement for Scalp Cooling
Paxman is encouraging healthcare providers to engage with a special contract that allows them to bill your insurance company directly. You can find the facilities with this business model via our system locator. This ensures that as many patients as possible are able to access scalp cooling, with the additional support of a Patient Assistance Program (PAP) for those who are under and uninsured.*
Private commercial payers, Medicare and Medicaid, may recognize the following codes for scalp cooling based on AMA CPT Editorial Panel’s recent coding update:
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.
Providers Billing Patient Insurance
To view a list of providers who are contacted with Paxman to bill your insurance company directly, visit our System Locator. If your provider is not or are unsure what contract they have with Paxman, have them contact us here.
Here are providers who offer scalp cooling:
Self Pay
If your provider does not have this type of contract with Paxman, they cannot bill your insurance provider, and therefore scalp cooling will be an out-of-pocket expense.
If you have concerns about the costs of scalp cooling, you will find information on foundation assistance and grants here.
Medicare and Medicaid have stated that ultimately they are now covering scalp cooling treatment however it may take time for all areas in the country to do so. Unfortunately, commercial insurers may not have clear coverage policies as yet but there is nothing to say that they won’t over time.
If you wish to pursue reimbursement with a private commercial payer the following may be of use:
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 the health benefit design, each patient may be responsible for a portion of the scalp cooling cost.
1. Obtain and complete the insurance reimbursement claim form from the insurer.
2. It is useful to include a copy of the JAMA publication on Scalp Cooling with your submission. We have prepared a synopsis here. View Here.
3. A letter of medical necessity will be required to be included in your submission. Download a sample here.
4. Ask your doctor for progress notes. Referencing the use of scalp cooling should be included in your submission.
5. Please include a copy of the claim for payment. Please request a specific itemized receipt from patient@PaxmanUSA.com
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.
“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.”
Maries
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.
Need more advice?