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. Success with reimbursement varies depending on plan, coverage, and location and CPT codes do not guarantee coverage.


For assistance with Reimbursement, please fill out this consent form Hub consent form and they will contact you within 2 business days.

 

The DigniCap Reimbursement Hub can work with you throughout the claim process to help you assemble and complete the documentation your insurance company needs, determine what benefits are available, assist if prior authorization is required before starting treatment, and help with any appeal process. 

If you have already filed a claim and received a denial of benefits, please contact the DigniCap Reimbursement Hub for assistance with an appeal. 


On July 1, 2021, two CPT codes for scalp cooling were issued, however, this type of code may only be used by providers who bill patients for DigniCap treatment. The new CPT codes are not intended for use by patients whose facilities have them purchase DigniCap kits and treatment cards directly from Dignitana.



Here are some general guidelines for your insurance reimbursement submission:


  • You will need to submit a claim form from your insurer


  • The ICD- 10-CM code on your claim form needs to match the diagnosis in your medical record exactly. The primary diagnosis code will likely be in the range of:

            0–C96.9 (Malignant neoplasm)

           C50-C56 (Malignant neoplasm of breast or female organs)


  •  Suggested secondary diagnosis codes are:

             Z51.11 (Encounter for antineoplastic chemotherapy)

             L65.9 (Nonscarring hair loss unspecified)


  • Suggested HCPCS codes that may be covered are:

            E1399 (durable medical equipment)     

            A9273 (Ice cap, cold wrap or pack)


  • Ask your physician for a Letter of Medical Necessity printed on your physician’s letterhead. 
  • 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 progress notes that reference that you are using scalp cooling to include with your claim.

 

Please note:

  1. Reimbursement may require multiple communications (by phone and writing) with the insurance company.
  2. Dignitana has no formal agreement with any Third Party Payer (insurance company) and is therefore not able to bill a third-party payer on behalf of the patient for the scalp cooling services.
  3. Please visit www.dignicap.com/insurance for insurance updates.