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November, 2024

Paxman Announces New CPT® Category I Codes from the AMA for Mechanical Scalp Cooling

Paxman, announces that in the Summary of Panel Actions issued on October 18, 2024, the American Medical Association (AMA) has issued 3 CPT® Category I codes for mechanical scalp cooling.

The Paxman Scalp Cooling System has been developed by the Paxman family to reduce hair loss in breast cancer patients undergoing chemotherapy. The concept behind the system came when the mother of four, Sue Paxman, experienced first-hand the trauma of chemotherapy-induced hair loss. With close to 5,000 systems delivered in to hospitals, clinics and treatment centres around the world, PAXMAN is the leading supplier of Scalp Cooling technology. PAXMAN’s scalp-cooling cap is made from lightweight, biocompatible silicone that is soft and flexible, providing a snug yet comfortable fit during treatment.

The new CPT® Category I codes for scalp cooling were published on the AMA website in September 2024 and will be effective starting January 1, 2026. The descriptors for these codes will be included in the CPT® 2026 code set, with an updated AMA publication expected in Q4 2025. These new codes represent a major milestone in the U.S. reimbursement process, positioning scalp cooling as a recognized medical necessity for managing chemotherapy-induced hair loss and moving closer to becoming a standard of care.

CPT® Codes are essential for tracking, reporting, and submitting reimbursement for medical procedures in the U.S. healthcare system. Unlike the previous CPT® Category III codes issued in July 2021 (0662T and 0663T), which were temporary and lacked assigned RVUs, the new permanent Category I codes will include RVUs, providing clear payment guidance and leading to more consistent reimbursement for scalp cooling treatments.

Richard Paxman, CEO, emphasized the importance of these CPT® codes for unlocking further insurance coverage and reimbursement, thanking partners like Dignitana, Dr. Steven Isakoff, and societies like ASCO, ACOG, and AAP for their support. The Paxman Scalp Cooling System is widely used in leading U.S. cancer centers and is an NCCN-recommended treatment since 2019.

Paxman Announces New CPT® Category I Codes from the AMA for Mechanical Scalp Cooling

The AMA Relative Value Update Committee (RUC) will evaluate three new CPT® Category I codes, making recommendations to CMS for assigning RVUs, which are key for physician compensation and Medicare reimbursement. After review, these RVUs will be incorporated into the 2026 Medicare Physician Fee Schedule (MPFS). The proposed rule will be released in July 2025, with finalization in November 2025 and effective January 2026.

Paxman’s insurance-based billing model for its scalp cooling system, designed to prevent chemotherapy-induced hair loss, is gaining adoption in the U.S. The new CPT® Category I codes are expected to boost this model, transitioning self-pay facilities to insurance-based billing and enhancing patient access. Most patients currently benefit from insurance coverage or a patient assistance program, with under 10% paying out of pocket.

For more information visit oncodaily.com