By Jaclyn Andronico, MSN, CNS, OCN^®, AOCNS^®

Financial Barriers to Scalp Cooling

Use of scalp cooling has grown in cancer centers across the United States; however, until recently it was an out-of-pocket expense for patients and limited to those who had the financial means to access this service. Initial estimated costs ranged from $1,500–$2,400 per chemotherapy cycle and hospitals varied in how they handled patient billing, with many patients paying a partial fee to the hospital and the remainder to the scalp cooling company.

In 2021, the American Medical Association introduced two current procedural terminology (CPT) codes that allowed providers to bill insurers directly for scalp cooling. In 2022, the Centers for Medicare and Medicaid Services created a payment rate for CPT code 0662T for “placement of device, monitoring, and removal of device.” 

Coverage Increases Access to Scalp Cooling Care

Today, some Medicare and Medicaid plans cover the service and more private insurance companies are following suit, increasing access to this service for patients receiving chemotherapy that is known to induce alopecia. Healthcare organizations are transitioning from a self-pay model to an insurance-based billing model where the institution purchases the scalp cooling cap kit and charges the patient’s insurance directly, using CPT codes for the cap fitting (CPT 0662T) and scalp cooling (CPT 0663T) before, during and after chemotherapy infusion.

How to Integrate and Educate About Scalp Cooling in Clinical Practice

With the growing opportunity for patients to access scalp cooling through their insurance, nurses are seeing an increase in patients who desire scalp cooling and who therefore require education on insurance coverage options. To provide patient-centered care, nurses collaborate with their interprofessional partners such as social work, patient financial services, administration, and physicians to establish standard processes for how and when these discussions are introduced to patients.

“The interprofessional team approach is essential for success in improving patient experience,” Ikuko Komo, MSN, CNS, AOCNS^®, AOCNP^®, a clinical nurse specialist at Memorial Sloan Kettering Cancer Center, said. At her institution, collaboration ensures that patient education and coordination of care occurs at the optimal time for the patient. Educating patients on financial obligations often takes place in the clinic at the time of treatment discussion.

“At our cancer center, we use talking points developed by the patient financial service office to guide clinicians in their conversations on scalp cooling as an option during the patient’s treatment,” Komo said. “This is to ensure patients are getting accurate and consistent information regarding the financial options on scalp cooling.”

Andrea Smith, MSN, RN, CBCN^®, a nurse leader for the Evelyn Lauder Breast Cancer Center at Memorial Sloan Kettering Cancer Center, reiterated the value of an interprofessional team in successfully helping patients access scalp cooling. “Partnering with the patient financial service department to create talking points for nurses and providers was essential to ensuring that clinicians have the right tools and resources at their disposal to engage in meaningful conversations with patients and caregivers about their scalp cooling treatment options and answer common questions related to costs and insurance reimbursement,” she said. “In addition, patient financial services should be involved in discussing alternative financial assistance options for patients who do not have insurance coverage for scalp cooling.”

Once the patient decides to move forward with scalp cooling, the nursing documentation in the electronic medical record for both the clinic and infusion setting generates the CPT codes necessary for reimbursement, Smith explained. She said that the documentation includes discussion of financial obligations, side effects, treatment length, and a description of the experience in the infusion unit.

Oncology nurses may also see patients more frequently taking the lead by contacting their insurance carriers and inquiring about their coverage options. Patients are advocating for themselves by identifying what options they can use to best fit their treatment plan but also rely heavily on nurses to guide them. Various resources exist to support both patients and nurses with the changing reimbursement landscape for scalp cooling (see sidebar).