INSURANCE COVERAGE

Insurance coverage for scalp cooling is not yet standard in the United States and does not have a specific CPT code. 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 has grown as more patients utilize this life changing treatment at infusion centers across the United States.

When submitting an insurance claim:

  1. Call your insurance provider to check benefits and obtain a blank claim form.
  2. The ICD code on the claim form needs to match your diagnosis code exactly. The diagnosis code will likely be in the range of:

              0-C96.9 (Malignant neoplasm)

  3. Suggested secondary diagnosis codes:

              Z51.11 (Antineoplastic chemotherapy)
              L65.9 (Nonscarring hair loss unspecified)

  4. Currently there is no unique CPT code for scalp cooling. Suggested CPT codes that may be covered are:

              E1399 (Durable medical equipment)
              A9273 (Ice cap, cold wrap or pack)
              A9282 (Wig any type, Cranial/scalp prosthesis)
              97039 (Constant attendance)

Suggested documentation to include with your reimbursement claim:

 

  1. Journal of the American Medical Association (JAMA) published scalp cooling study – CLICK HERE to view the abstract
  2. Oncology Research and Treatment published study on scalp cooling – CLICK HERE to view the abstract
  3. Include a Letter of Medical Necessity from your doctor. – download sample letter of medical necessity here
  4. Ask your doctor’s office for progress notes that reference that you are using scalp cooling.
  5. Ask your doctor for a MD Order or prescription for scalp cooling.
  6. Include receipt of payment for scalp cooling treatment.

Dignitana is a Third-party Out-of-Network provider, and has no formal agreement with any Third-Party Payer (insurance company). Dignitana 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.

Note that Dignitana does not have an NPI (National Provider Identification) number. If your insurance provider requests Dignitana’s Tax ID number, contact the Patient Support Center.

Note that reimbursement may require multiple communications (by phone and in writing) with the insurance company. 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 affect any reimbursements, depending on the plan details.

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.

Flexible Spending Accounts (FSA) can often be used to pay for medical expenses not covered by insurance. Contact your provider to assess if you can apply funds to your scalp cooling therapy.

Please share your experience regarding scalp cooling and insurance by taking the survey at scalpcoolingsurvey.com 

For information on organizations offering patient assistance to scalp cooling patients CLICK HERE.

Please note that the content of this website is not intended as professional medical or healthcare advice and should not be construed as a substitute for professional healthcare advice, or services from a qualified professional healthcare provider familiar with your unique situation. This content is intended solely as a general product and corporate information.

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Dignitana AB
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226 60 Lund, Sweden
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