Insurance reimbursement for scalp cooling
If your healthcare provider has the appropriate contract with Paxman, they will be able to bill your insurance company directly. This ensures that as many patients as possible can access scalp cooling. As a part of the contract, there is the additional support of a Patient Assistance Program for those who are under- or un-insured.*
Your healthcare provider will talk you through the process to initiate scalp cooling, and will take the appropriate actions to ensure that you are able to access scalp cooling either through insurance or the Patient Assistance Program.
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.
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.
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.
Self-Pay
Scalp cooling has been an out-of-pocket expense for a long time, and for a lot of patients this is still the case.
The cost of scalp cooling is as follows:
No charge
$350 per treatment
$200 per treatment
$100 per treatment
$2400
Pricing per patient is capped at:
Some healthcare providers may use slightly different pricing, please check with your clinical team for more information.
Financial Support
If you are concerned about the cost of scalp cooling, there are foundations and charities that may be able to help you cover at least some of the costs of scalp cooling. Each foundation has different support criteria, often based on Federal Poverty Level, though this is not always the case.
Make sure you do your research and know what you qualify for.
We are incredibly proud to work with HairToStay, the only national Financial Support Partner for scalp cooling.
HairToStay are a non-profit organization who help subsidize patients having scalp cooling throughout the United States. They have awarded 1,000s of subsidies to date, as well as raising awareness of scalp cooling and providing patient support.
Click the link below to visit their website and learn more about HairToStay, eligibility requirements, and how to apply for a subsidy.
Learn more about HairToStay
For more information on regional, local or site-specifc foundation support, please speak with your clinical team.
Some foundations provide support at a local level and may be associated with a specific health system or center. Speak with your clinical team for more information.
Can I pursue reimbursement with my commercial payer?
We are seeing coverage in parts of the US by Medicare, Medicaid, and some commercial insurers. If you wish to pursue reimbursement with a commercial payer, the following may be of use
01
Obtain and complete the insurance reimbursement claim form from the insurer.
02
It is useful to include a copy of the JAMA publication on Scalp Cooling with your submission. We have prepared a synopsis
here.03
A letter of medical necessity will be required to be included in your submission. Download a sample
here.04
Ask your doctor for progress notes. Referencing the use of scalp cooling should be included in your submission.
05
Please include a copy of the claim for payment. Please request a specific itemized receipt from patient@PaxmanUSA.com
06
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.
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.