INSURANCE & REIMBURSEMENT
Although insurance coverage for scalp cooling is not yet standard in the United States, DigniCap patients have submitted insurance claims and received reimbursement for treatment costs at varying levels since DigniCap received FDA clearance in 2015.
As of July 2021, two new CPT codes for scalp cooling providers will go into effect, however, this type of code may only be used by providers who bill patients for DigniCap treatment. The new CPT codes are not valid for patients whose facilities have them purchase DigniCap kits and treatment cards directly from Dignitana.
CPT codes do not guarantee coverage. Success with reimbursement varies depending on plan, coverage, and location.
Our Patient Support Team is here to help as you navigate the reimbursement process with your insurance company. Contact the DigniCap Reimbursement Hub at 800-918-3441 or by clicking the link below.
> Did you purchase a DeltaKit and DeltaCards directly from DigniCap?
How do I get started?
- Call your insurance provider to check benefits and obtain a blank claim form.
- Ask your provider if they require pre-authorization for scalp cooling treatments.
- File for reimbursement using the coding guidance below.
- Obtain invoices for DigniCap purchases from the DigniCap Patient Support Center.
- Ask your provider for the treatment order and notes related to DigniCap usage.
What codes should I use?
- Suggested CPT codes are:
E1399 (Durable medical equipment)
A9273 (Ice cap, cold wrap or pack)
The ICD-10-CM diagnosis code on the claim form needs to match the diagnosis in the medical record exactly.
The primary diagnosis code will likely be in the range of:
C50-C56 (Malignant neoplasm of breast or female organs
0-C96.9 (Malignant neoplasm)
Suggested secondary diagnosis codes:
Z51.11 (Encounter for antineoplastic chemotherapy)
L65.9 (Nonscarring hair loss unspecified)
Patients should ask their provider for the treatment order and notes related to DigniCap usage.
What documentation do I need?
The following documents are available from the DigniCap Patient Support Center to support reimbursement claims:
Sample Letter of Medical Necessity for provider to complete on letterhead with your information
Published clinical literature supporting DigniCap use
FDA clearance letter with Indication for Use
NCCN Clinical Practice Guidelines in Oncology listing scalp cooling as a Category 2A recommendation
ONS Guidelines™ for Cancer Treatment recommendation for scalp cooling
> Can I use other types of Health Care Accounts?
Patients with a Flexible Spending Account (FSA), Health Savings Account (HSA) or other health care accounts may be able to use those funds for scalp cooling expenses not covered by insurance. Check with your account administrator.
> What about the new CPT codes that started July 2021?
Two new Category III CPT® codes for scalp cooling were introduced on July 1, 2021:
- 0662T: Scalp cooling mechanical; initial measurement and calibration of cap
- +0663T: Placement of device, monitoring, and removal of Device
The new CPT® codes are not valid for reimbursement claims submitted by patients to insurance companies. The two codes above can only be used by providers who bill insurance companies on behalf of patients for DigniCap. Ask your health care provider to contact DigniCap for details.
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) and Health Savings Accounts (HSA) 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.
The information received is for informational purposes only and represents no statement, promise, warranty or guarantee by Dignitana concerning levels of reimbursement, payment, or charge; nor that reimbursement will be received. This reimbursement guide is for informational purposes only and information provided should not be considered legal advice. As with all claims, individual physicians and hospitals are responsible for exercising their independent clinical judgment in selecting the codes that most accurately reflect the patient’s condition and procedures performed for a patient. Insurance coverage is based on several factors including the medical necessity of the treatment for the patient’s medical condition, the patient benefits, and the provider contract. Reimbursement varies by insurer, state, contracts, and other factors. Dignitana, DigniCap, DigniCap Delta, DeltaCard and DeltaCool are registered trademarks owned by Dignitana AB. Current Procedural Terminology 2021, American Medical Association. Chicago, IL 2020. CPT is a registered trademark of the American Medical Association. Current Procedural Terminology (CPT®) is copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
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