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Medicare Physician Fee Schedule Proposed Rule Assigns 2026 Payment Rates to Three New CPT® Codes for Mechanical Scalp Cooling
Prenumeration
Beskrivning
| Land | Sverige |
|---|---|
| Lista | First North Stockholm |
| Sektor | Hälsovård |
| Industri | Medicinteknik |
Paxman announces the U.S. Centers for Medicare & Medicaid Services (CMS) has published its Medicare Physician Fee Schedule (MPFS) Proposed Rule for Calendar Year (CY) 2026, which assigns reimbursement rates for the three new Category I Current Procedural Terminology (CPT®) codes for mechanical scalp cooling.
Following a public comment period ending September 12, 2025, and any resulting revisions, the Final Rule will be published by CMS in November 2025. The new MPFS rates and corresponding CPT codes will become effective January 1, 2026.
Specific codes and descriptors will be published by the American Medical Association (AMA) in the 2026 CPT® Code Set. In this Proposed Rule CMS has assigned preliminary payment rates for mechanical scalp cooling as follows:
| CPT® codes for mechanical scalp cooling and brief description | Medicare Physician Fee Schedule CY 2026 Rates | Example: MPFS rate for 6 scalp cooling treatments* | |
| 9XX01 | Initial cap fitting and patient education | $1,701 per patient, per treatment cycle | $1,701 |
| 9XX02 | Pre-cooling period | $10 per treatment | $60 |
| 9XX03 | Post-infusion cooling, per each 30 minute period | $6 per unit, per treatment | $144 |
| $1,905 Total per patient | |||
*Average number of treatments per patient is six. Average post infusion cooling time is up to 120 minutes.
Richard Paxman, CEO, commented, “We commend CMS for taking a critical step forward in standardizing scalp cooling reimbursement rates for Medicare recipients by adding scalp cooling to the Medicare Physician Fee Schedule. While the assigned rates are lower than hoped, this is undeniably a positive stride toward ensuring more cancer patients can access scalp cooling, a vital treatment that significantly reduces chemotherapy-induced hair loss.”
It is noted that CMS disagreed with the RUC* recommended 5 minutes of service period clinical staff time for CPT 9XX01. CMS proposed 27 minutes, based on reference CPT code 99453 (Remote monitoring of physiological parameter(s) (for example weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment), which better accounts for the full duration of time required for this service which was based on feedback from interested parties. CMS, however, agreed with the RUC on all other direct PE inputs, supplies, and equipment for CPT codes 9XX02 and 9XX03 without refinement. It is, therefore, critical that work continues with partners across the US Healthcare system to educate CMS on the work and value of codes 9XX02 and 9XX03.
Richard Paxman added, “This move by CMS sends a powerful message to all payers: the time is now to prioritize coverage for scalp cooling to meet the growing demand for this essential therapy and improve healthcare equity. Although this progress with CMS is very important, currently only 20 percent of our patients are Medicare eligible. While we are working to improve access for all, more than 85 percent of our patients are insured by commercial payers. If we look at our available data on CPT III codes, approximately 75 percent have received positive coverage via our insurance-based billing model. The MPFS rates are important in this respect, as they provide critical guidance for commercial payers, who typically pay at a much higher rate.”
These three new Category I codes were issued by the AMA in response to increased utilization of clinically proven mechanized scalp cooling systems, such as Paxman and DigniCap, and the demonstrated work performed by healthcare professionals to educate patients and administer these treatments. Importantly, these codes are not applicable to manual cold caps or mechanical systems that are self-administered by patients.
The successful switch to Category I codes underscores the clinical value of this treatment and provides a clear pathway toward fair reimbursement of the professional work involved in administering scalp cooling.
The new reimbursement codes complement the recent favorable Local Coverage Determination by the Palmetto Medicare Administrative Contractor as well as legislative action introducing a coverage mandate for scalp cooling in New York state beginning in January 2026. Several additional states are also considering similar bills this year. These broad-reaching actions collectively aim to expand patient access to scalp cooling and improve healthcare equity for cancer patients.
In 2021, two temporary CPT® Category III Codes for mechanical scalp cooling, 0662T and 0663T, were issued by the AMA. With the issuance of the three new Category I Codes in 2026, the two current Category III codes will become invalid.
Current FDA-cleared machine-based cooling systems, like the Paxman Scalp Cooling System and the DigniCap Scalp Cooling System, are used in cancer treatment centers at over 900 locations in the United States, including 59 NCCN and NCI-designated Comprehensive Cancer Centers. Scalp cooling is also included in the NCCN Guidelines and Compendium as a Category 2A treatment option.
In May 2025, Paxman acquired Dignitana. The two companies have merged to create a new, unified group under Paxman AB. The undeniable synergistic value will enable Paxman to navigate and transform the evolving U. S. reimbursement landscape with greater agility and strength, expanding equitable patient access to the treatment.
If you would like to find out more about Paxman’s Scalp Cooling System visit: www.paxmanscalpcooling.com
* The Relative Value Scale Update Committee (RUC) is an extension of the AMA and national medical specialty societies and serves as an expert panel in developing recommendations for relative value units to CMS.