Insurance Coverage Information
Insurance Coverage for The DigniCap® Scalp Cooling System
Insurance does not currently cover scalp cooling treatments. With increasing awareness and success stories, patient demand is growing for insurance companies to establish coverage for use of this therapeutic medical device.
Although insurance coverage for scalp cooling is not yet standard and there is not a unique CPT code for scalp cooling., DigniCap patients have submitted insurance claims and received reimbursement for treatment costs at varying levels since DigniCap received FDA clearance in 2015.
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.
Insurance reimbursement may require multiple communications with the insurance company, coverage varies among individual plans and may be dependent on policy coverage, location, and other factors stipulated by the insurance provider.
Coding, coverage, and payment of medical scalp cooling therapeutics for the prevention of chemotherapy-related alopecia has not yet become an industry standard. As it currently stands, one can bill for the use of the DigniCap system using CPT 97039 (constant attendance, physical medicine, scalp cooling, unlisted modality) until a new and unique CPT code is established. However, billing an insurance company for the DigniCap service using CPT 97039 may not result in payment as the scalp cooling service may or may not be covered by the insurance company. 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.
In terms of other means of patient 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.
Find out where The DigniCap® Scalp Cooling System is currently available.