LCD/NCD Portal

NCD110.6

 

SCALP HYPOTHERMIA DURING CHEMOTHERAPY TO PREVENT HAIR LOSS

 

Effective Date of this Version

• This is a longstanding national coverage determination. The effective date of this version has not been posted.

 

Benefit Category

• Incident to a physician's professional Service.

• Outpatient Hospital Services Incident to a Physician's Service.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

• Keeping the scalp cool during chemotherapy has been noted to reduce the risk of hair loss.

• The cooling may be done by packing the scalp with ice-filled bags or bandages, or by specially-designed devices filled with cold-producing chemicals activated during chemotherapy.

 

Indications and Limitations of Coverage

• While ice-filled bags or bandages or other devices used for scalp hypothermia during chemotherapy may be covered as supplies of the kind commonly furnished without a separate charge, no separate charge for them would be recognized.

 

Medicare NCD Link