Q: Is cold cap therapy covered by insurance?
A: Check with your individual carrier. Note that even if cold cap therapy is not covered at this time, plans and benefits evolve. As the cost of cold caps is likely to be comparable to the cost of a medically prescribed wig, insurance acceptance of cold caps is likely to grow. In fact either cold caps or medically prescribed wigs should be treated as a cranial hair prosthesis. Some plans do cover this, and this is how your physician's prescription should be written.
A 2016 patient advises that she has submitted for reimbursement using a primary diagnosis code of L65.9 for a cranial prosthesis. This appears to be a new code - and she was told the info below is no longer current. However we are leaving it posted at this time in case it still has any usefulness.
In 2014 we learned a patient was successful with insurance! The patient wrote:
I wanted to let you know that after denying my claim for cold caps, Anthem Blue Cross reversed themselves and paid. Below are the procedure and dx codes that did the trick. The first time they denied I called up and asked for the basis of the denial and checked what code they had used. They had changed the procedure code to an unspecified code and denied on that. My appeal was for them to process as the doctor had ordered. They did and paid ($1073 out of $1700 submitted). Please encourage others with and without Blue Cross to submit. Every time someone gets paid, it is a victory.
Cranial prosthesis A9282
dx alopecia for chemotherapy 704.00
We previously learned of a New York State employee whose insurance (through the state) did pay for about 85% of her cold cap rental expenses. Here's her story:
My oncologist's prescription stated that it was for a "Full Hair Prosthesis" for chemo induced alopecia, dx. code 179.9. When I telephoned my insurance company, they told me they would cover up to $1,500 for the cost of a wig.
After I completed chemo, I submitted the prescription, an invoice from MSC-Worldwide, and copies of my credit card statements showing the monthly fees I paid. (I submitted nothing about the deposit.) The insurance company first rejected my submission with no explanation code. I followed up by telephone and was told they rejected it because it was for a rental, not a purchase. I argued that no one told me about a rental exclusion etc. and they very nicely said that they would resubmit the claim, which much to my surprise, they then paid!
For further discussion of insurance coverage for cranial prostheses for chemo-induced hair loss, please read here.