#United States #San Diego #Medicare #Scalp Cooling #Cooler Heads

Introduction

In a noteworthy development for cancer patients, Cooler Heads, a company committed to improving access to scalp cooling technology, has announced a groundbreaking step forward in the healthcare industry. The Centers for Medicare & Medicaid Services (CMS) has included new CPT codes related to mechanical scalp cooling in the 2026 Medicare Physician Fee Schedule (MPFS). This historic move aims to enhance the accessibility and affordability of scalp cooling treatment for individuals undergoing chemotherapy, who often face the distressing side effect of hair loss.

Importance of Scalp Cooling

Chemotherapy, a common treatment for various types of cancer, is often accompanied by severe side effects, including hair loss. For many patients, this loss can significantly impact their emotional well-being and identity. Scalp cooling systems, specifically designed to preserve hair during treatment, represent a viable solution. These systems work by cooling the scalp to constrict blood vessels and reduce the absorption of chemotherapy drugs that typically lead to hair loss.

New Medicare Codes

The introduction of three new Category I CPT® codes for scalp cooling marks the first time such procedures have been recognized in the Medicare Physician Fee Schedule. According to Kate Dilligan, Founder and CEO of Cooler Heads, this initiative is a monumental stride towards ensuring consistent reimbursement for patients who utilize this technology. The newly proposed payment scales are as follows:
1. Initial Fitting and Education: The first code includes reimbursement for the initial fitting of the scalp cooling cap and patient education, valued at $1,701.
2. Pre-Infusion Cooling: The second code pertains to the pre-infusion cooling period, proposed at $10 per treatment.
3. Post-Infusion Cooling: The third code covers the post-infusion cooling period, reimbursed at $6 for every 30 minutes.

Despite these advancements, it is essential to note that the new codes do not apply to traditional manual cold caps, emphasizing the necessity for FDA-cleared mechanical scalp cooling systems such as the Amma™.

Future Implications

The CMS's decision to introduce these codes not only assists patients directly but could also lead private insurance companies to reevaluate and establish their coverage guidelines, broadening the access to patients needing scalp cooling. Furthermore, the public comment period for these proposed changes will conclude on September 12, 2025, after which CMS will release the Final Rule in November 2025, solidifying these provisions.

Conclusion

Cooler Heads aims to collaborate with healthcare systems to maximize patient access to these pivotal treatments. With the implementation of the new Medicare codes scheduled for January 1, 2026, the future appears hopeful for many patients facing the challenges of cancer and its treatments. By improving access to effective scalp cooling systems, Cooler Heads not only advocates for better health outcomes but also supports the emotional well-being of those battling cancer.

Cooler Heads, founded by a cancer survivor, focuses on providing evidence-based products, information, and services that assist cancer patients in mitigating the severe side effects of their treatments, thereby enhancing their quality of life.