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 will continue to build as more patients utilize this life changing treatment at infusion centers across the United States.
For your insurance reimbursement submission:
- Obtain a blank claim form from your insurer.
- ICD codes on your claim form need to match your diagnosis exactly. These will likely be in the range of:
0–C96.9 (Malignant neoplasm)
- Suggested ICD diagnosis codes are:
Z51.11 (Antineoplastic chemotherapy)
L65.9 (Nonscarring hair loss unspecified)
- You may need to provide a CPT procedure or service code. Currently there is no unique CPT code for scalp cooling. Suggested CPT codes are:
97039 (Constant attendance)
A9273 (Ice cap, cold wrap or pack)
A9282 (Wig any type, Cranial/scalp prosthesis)
Suggested documentation to include with your reimbursement claim:
- Journal of the American Medical Association (JAMA) published scalp cooling study – CLICK HERE to view the abstract
- Oncology Research and Treatment published study on Scalp Cooling – CLICK HERE to view the abstract
- Ask your doctor for a letter of medical necessity to include in your submission to the insurance company – download sample letter of medical necessity here
- Ask your doctor for progress notes that reference that you are using scalp cooling to include with your claim
You may wish to talk to the financial coordinator at your doctor’s office if you have additional questions about your reimbursement paperwork.
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.
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.
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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