Are Penguin Cold Caps Covered By Insurance?
Published: 23 Nov 2021
Insurance Coverage for Cold Capping or Scalp Cooling is currently not fully reimbursable.
At the moment, scalp cooling is currently at your expense. We encourage you to submit claims in hopes of receiving some reimbursement. We have heard some providers may pay up to 70-80%!
Many factors contribute to the amount received, such as location, deductibles, and the coverage of your medical plan.
Penguin Cold Caps does not have a formal agreement with any insurance company.
We are considered a third-party out of network provider.
You must submit the claim to your insurance company – We do not bill your insurance.
Before calling your insurance to check your benefits. You must have your Diagnosis Code from your Physician. It’s also referred to as a ICD-10 code.
Common codes are,
- ICD-10 Z51-11 Anti Neoplastic Chemotherapy
- ICD-10 L65.9 Chemo Induced Alopecia
- ICD-10 D09.9 Malignant Neoplasms
- ICD-10 C50.919 Malignant Neoplasm of breast
Call your Insurance provider to check your benefits & obtain a claim form.
It may be worth asking your provider if they require preauthorization for Scalp Cooling/Cold Capping.
You will need to provide them with ICD-10 code from your Physician.
Now you need to check if they will cover you for the following codes,
- A9273 – Cooling Caps, Cold/Hot Wrap or Pack
- A9282 – Wig any type, Cranial/Scalp Prothesis
- E1399 – Durable Medical Equipment Misc.
- 97010 – Hot/Cold Packs
- 97039 – Constant Attendance Physical Medicine
Now you know if they will cover you & what CPT & ICD-10 code to use.
Fill out the form your insurance company has provided.
Email: firstname.lastname@example.org & we will provide an itemized statement for you to include with your insurance claim form.
You should know that you can try to claim for dry ice, as it is required to use our system – although reimbursement does vary.
Make sure you keep your receipts for each purchase & submit it with your insurance claim.
Note: Sometimes it good to include a progress note from your physician, referencing the use of scalp cooling.
We cannot contact your doctor or your insurance to assist due to HIPPA Privacy Laws
“Aetna considers scalp cooling (i.e., using ice-filled bags/bandages, cryogel packs, or specially designed products (e.g., Chemo Cold Cap, DigniCap, ElastoGel, Paxman Scalp Cooling System and Penguin Cold Cap)) medically necessary as a means to prevent hair loss during chemotherapy.
Note: Cooling caps and other products for scalp cooling are considered incidental to the chemotherapy administration and are not separately reimbursed. Cooling caps and other scalp cooling products purchased by the member are considered supplies that are generally excluded from coverage under plans that exclude supplies. See benefit plan descriptions.
CPT codes covered if selection criteria are met:
- 0662T – Scalp cooling, mechanical; initial measurement and calibration of cap
- 0663T – Scalp cooling, mechanical; placement of device, monitoring, and removal of device (List separately in addition to code for primary procedure)
ICD-10 codes covered if selection criteria are met:
- C00.0 – C96.9 Malignant neoplasms
- D00.00 – D09.9 In situ neoplasms
- Z51.11 -Encounter for antineoplastic chemotherapy”
“Non-Covered Service – Benefit Exception”
“0662T – Scalp cooling, mechanical; initial measurement and calibration of cap – CPT-4”
“0633T – Scalp cooling, mechanical; placement of device monitoring and removal of device – CPT-4”
Should call to check for Benefit Exception.
” Scalp Hypothermia During Chemotherapy to Prevent Hair Loss (NCD 110.6)
Keeping the scalp cool during chemotherapy has been noted to reduce the risk of hair loss. The cooling may be done by
packing the scalp with ice-filled bags or bandages, or by specially-designed devices filled with cold-producing chemicals
activated during chemotherapy.
While ice-filled bags or bandages or other devices used for scalp hypothermia during chemotherapy may be covered as
supplies of the kind commonly furnished without a separate charge, no separate charge for them would be recognized.
The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive.
Listing of a code in this guideline does not imply that the service described by the code is a covered or non-covered health
service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws
that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or
guarantee claim payment. Other Policies and Guidelines may apply.
- CPT Code – 97010 -Application of a modality to 1 or more areas; hot or cold packs
- HCPCS code – E1399 – Durable medical equipment, miscellaneous”