PAXMAN Announces US Centers for Medicare and Medicaid Services (CMS) Continues to Support Scalp Cooling, but Reduces Reimbursement Level for 2024

CMS OPPS Final Rule for 2024: CMS continues to support scalp cooling but reduces reimbursement levels from $1,850.50 to $1,250.50 for 2024 under the Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System.

Importance of CPT Code 0662T: Continued support for the 0662T CPT code allows practitioners to bill for scalp cooling services, ensuring patient access under Medicare.

2021 Data Used for Decision: The reimbursement level reduction was based on data from 2021, the first year of CPT code use for scalp cooling. Less than 5% of providers submitted claims in 2022, highlighting the need for a larger dataset for more accurate reimbursement adjustments in 2025.

Paxman and Dignitana Appeal: Paxman and Dignitana collaborated to appeal the 2024 reimbursement reduction, arguing that the current data is insufficient for a reduction decision.

Positive Trends in Claims Submission: Strong adoption of scalp cooling services among US cancer centers, with 71% of claims submitted in 2022 and 2023 resulting in positive coverage from commercial payers.

Commercial Payers: Payment for code 0662T ranges from $928 to $4,857 per patient, with additional reimbursements under code 0663T ranging from $78 to $1,200 per treatment.

Medicare Patients: Currently, fewer than 15% of scalp cooling patients are Medicare-eligible, as most are under 65.