Dignitana

Dignitana AB announces today that the US Centers for Medicare & Medicaid Services (CMS) has published the  OPPS Final Rule, which continues to support scalp cooling but decreases the average rate from $1850.50 to $1250.50 under the  Hospital Outpatient Prospective Payment System (OPPS) and the  Ambulatory Surgery Center (ASC) payment system for Calendar Year (CY) 2024.

Although the 2024 rate is lower, the Final Rule does continue to support the consistent use of the 0662T CPT code, which is important to allow practices to bill for scalp cooling services and ensure access to scalp cooling for patients with Medicare coverage.

This action was based on claims data from 2021, which was the first year the scalp cooling CPT codes became effective. Fewer than 5 percent of the over 75 providers currently filing claims for scalp cooling were doing so in 2022. This directly supports our assertion that a larger data pool will be available to better inform accurate rate setting for CY 2025. When the CY 2024 proposed rule was published in July 2023 Dignitana and Paxman worked in collaboration to appeal the payment rate decrease, stating to CMS that the data represented only a small volume of claims that did not provide sufficient cost data to inform a change in rate setting at this time.

"We are committed to advancing scalp cooling to standard of care so that all patients have access to scalp cooling," said Dignitana CEO Catarina Löwenadler. "While we are disappointed to see that CMS did not accept our request to maintain the rate for 2024, we are pleased that growing number of providers are now adopting our Buy and Bill model so they can bill for the scalp cooling service they are administering. We believe that data from claims filed in 2022 will illustrate to CMS that this therapy merits stronger support in 2025."

Reimbursement for scalp cooling was initiated in 2021 with the introduction of the two CPT codes, 0662T and 0663T. Since that time commercial payers have responded favorably to the new coding in claims filed by providers.  A review of scalp cooling claims filed through August 2023 with code 0662T indicates that commercial plans are paying well above Medicare rates for this covered benefit. An analysis of claims filed in 2022 and 2023 by Paxman and Dignitana providers found that 71 percent of claims filed resulted in positive coverage.  For commercial payers reimbursing providers for code 0662T, the range of payments is $928 - $4857 per patient, with an additional reimbursement under the second 0663T code of $78 - $1200 for each treatment. Further review shows that fewer than 15 percent of patients currently receiving scalp cooling are over 65 and would be Medicare eligible.