PAXMAN AB PAXMAN announces that the Palmetto Medicare Administrative Contractor (MAC) has issued a Proposed Local Coverage Determination (LCD) to provide coverage guidance for Scalp Cooling for the Prevention of Chemotherapy-Induced Alopecia. The draft policy recommends coverage be considered reasonable and necessary for FDA cleared devices as long as the patient does not have any of the listed contraindications. This is the first LCD that has been proposed for scalp cooling.
A MAC is a private health care insurer that has been awarded a geographic jurisdiction to process claims for Medicare beneficiaries. The Palmetto MAC services two jurisdictions in the US Medicare system covering seven states in the southern US:
CMS assigns MACs the task of developing coverage articles that give direction on how to bill or code for a service or to provide education on a specific topic. The Draft Article - Billing and Coding: Scalp Cooling for the Prevention of Chemotherapy-Induced Alopecia will be updated at the close of the review process.
This action proposing localized coverage further advances support for health care providers to receive reimbursement from Medicare to administer FDA-cleared scalp cooling therapy, such as Paxman Scalp Cooling System. Two separate CPT® Category III Codes for “mechanical scalp cooling,” 0662T and 0663T, were issued by the AMA with an effective date of
The
The proposed scalp cooling LCD will be discussed at two Open Meetings of the
If approved, the Palmetto LCD would provide a pathway for successful reimbursement of Medicare scalp cooling claims for patients in the seven-state service area early in 2024.
© Modular Finance, source
