I want to scalp cool

Insurance
Reimbursement

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.

Paxman is a third-party out-of-network provider, and has no formal agreement with and third-party payer (insurance company). Paxman cannot bill a third-party payer on your behalf for scalp cooling services, Coding, coverage and payment of medical scalp cooling therapeutics for the prevention of chemotherapy-related alopecia has not yet become industry standard. Please note that Paxman does not have an NPI (National Provider Identification) number. If your insurance provider requests Paxman’s Tax ID number, please contact our office on 888-572-9626.

Here are some steps to support provider reimbursement

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.  In order to receive an itemized receipt please request a receipt from the Paxman Hub, they can be reached at 844-572-9626.  Once received, please forward this to patient@PaxmanUSA.com along with your facility name, location and dates of service.  An itemized receipt will be returned to you within 24 hours.

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. 

As of July 2021, two new CPT codes for scalp cooling providers will go into effect.  These codes can only be used by providers who bill patients directly for Paxman scalp cooling treatments. The new CPT codes are not recommended for patients who purchase Paxman scalp cooling treatments directly from the Paxman Hub.

CPT codes do not guarantee coverage. Success with reimbursement varies depending on plan, coverage, and location.

Paxman are here to help as you navigate the reimbursement process with your insurance company; please contact us on 888-572-9626 for support.

You may find the following CPT codes useful when applying for reimbursement:

97039 (Cooling Cycles; Constant attendance)
A9273 (Cooling Caps, Cold wrap or pack)
E1399 (Durable medical equipment)
A9282 (Wig any type, Cranial/Scalp Prosthesis)
97010 (Hot/Cold Packs)

“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.

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