Paxman HUB Services and PAP Model

As a result of these developments the Paxman HUB/PAP model is available and has been put in place with multiple healthcare systems. Currently, we are seeing 90% of claims paid, and patient enrolments have increased by 120% at sites that have adopted the Paxman scalp cooling reimbursement model – thereby proving that patients are increasingly selecting providers based on the availability of equitable individualized cancer care.  

Furthermore, as part of the Paxman HUB/PAP model, we provide a robust Patient Assistance Program (PAP) to ensure that those who are uninsured or underinsured are still able to access scalp cooling during chemotherapy treatment. This is an important initiative for Paxman and is therefore set at six times the federal poverty level based on household income and household size. This will enable broader access to scalp cooling and more equitable access across the United States.  We are pleased to confirm that all practices that have applied to scalp cool have been able to access the treatment, either via payer claims paid or through the Paxman Patient Assistance Program (PAP).

Facilities contracting with Paxman for the HUB/PAP Model have the support of Paxman HUB services to assist with Benefits Investigations (BI’s), Prior Authorizations (PA’s) and the Appeals process if required.  To date, BI’s have shown coverage success in 80% of individual patient cases..  Feedback shows that Providers are seeing claims paid as expected. The Paxman PAP has ensured that the remaining 20% of patients have still been able access scalp cooling treatment.

Scalp Cooling CPT Codes

At their 2022 Annual Meeting of the House of Delegates, the American Medical Association (AMA) acknowledged the efficacy and benefit of scalp cooling to the patient. They highlighted the lack of coverage for the treatment, despite many insurers covering the cost of wigs for chemotherapy patients. Following this CPT III codes 0662T and 0663T were reassigned to scalp cooling.

As a result, CMS has provided clarity on the payment process for scalp cooling and the payment rate will be maintained through the calendar year 2023. This ruling will affect 3,411 hospitals and approximately 5,500 ASCs. 

The Ambulatory Payment Classification (APC) payment assignment under the New Technology code of 1520, and the payment rate of $1,850.50, is important to allow practices to bill for scalp cooling services for Medicare patients.

Implementing Scalp Cooling Reimbursement

A 2018 study found that 14.8% of all Medicare beneficiaries have a cancer diagnosis. Over 450 locations across the USA already offer Paxman scalp cooling as a self-pay treatment, so in transitioning to the Paxman reimbursement model, your patients can access scalp cooling without the self-pay financial burden.

Whether you’re already a Paxman provider or looking to implement a scalp cooling program at your facility, for more information on how your healthcare system can implement the Paxman reimbursement model, get in touch with our team.