Insurance Coverage Information

Updated Aug 22, 2017  – for notification of future insurance updates email

Insurance coverage for scalp cooling is not yet standard in the United States, however DigniCap patients have submitted insurance claims and received reimbursement for treatment costs at varying levels since DigniCap received FDA clearance in 2015. Success with reimbursement varies depending on plan, coverage, and location. With the  July 2017 expansion of DigniCap clinical indications to include patients with solid tumors, claims for reimbursement and demand for coverage will continue to build as more patients utilize this life changing treatment at infusion centers across the United States.

Here are suggestions for your insurance reimbursement submission:

  1. Obtain the blank reimbursement claim form from your insurer (you may be able to download this from their website)
  2. If you are using form CMS 1500 for Medicare, directions are posted here
  3. DIAGNOSIS – Ensure ICD codes on claim form you submit exactly match your diagnosis. Your diagnosis code will likely be in this range: 0 – C96.9 (Malignant neoplasms)
  4. DIAGNOSIS -In the same diagnosis box, provide a second diagnosis code of Z51.11 (Encounter for antineoplastic chemotherapy)
  5. PROCEDURE, SERVICE OR SUPPLY – enter CPT code 97039 (Constant attendance, physical medicine, scalp cooling, unlisted modality). There is not a unique CPT code for scalp cooling, and a CPT code may not be required on your form if other criteria are met.
  6. CHARGE – Ask your Third Party Payer (insurance company) how they prefer to have this section completed
  7. Include a copy the Feb 14 JAMA Article on Scalp Cooling – download it here
  8. Include a copy the Oncology Research and Treatment article on Scalp Cooling – download it here
  9. Ask your doctor for a letter of medical necessity and include that in your initial submission to the insurance company – download sample here
  10. Ask your doctor for progress notes that reference that you are using scalp cooling and include that in your initial submission to the insurance company
  11. Reimbursement may require multiple communications (by phone and in writing) with the insurance company.
  12. Insurance coverage varies among individual plans and may be dependent on policy coverage, location, and other factors stipulated by the insurance provider. Co-pays and minimums may also effect any reimbursements, depending on the plan details.

Talk to the financial coordinator at your doctor’s office if you have additional questions about how to file for reimbursement.

Dignitana has no formal agreement with any Third Party Payer (insurance company) and therefore 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 an industry standard. Requesting reimbursement from a third party payer may not result in payment. Scalp cooling service may or may not be covered by the insurance company. Criteria such as co-pays and minimums may be a factor, and the dollar amount of coverage may vary. If it is not covered, no payment would result.  Additionally, there may be circumstances where the service is covered and thus can be used on a patient and billed for, but no additional payment would result.

To provide patients with financial assistance, Dignitana was a founding partner and continues to be a strong supporter of HairToStay, a national non-profit foundation that provides subsidies to scalp cooling patients with demonstrated financial need. In addition, some facilities have utilized funding from medical center foundations, community health funds and other philanthropic entities to support scalp cooling in their community.

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