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Medicare coverage for facial wasting?

Jun 21, 2011

Does Medicare cover the doctors' cost for the filler product separately from the doctor's procedure fee? Perhaps the patient could pay the procedure fee to the doctor as is done on a patient assistance plan if the doctor has the product cost covered?

Response from Dr. Pierone

Hello, and thanks for posting.

Medicare does have facial fillers codes that are separate from the procedure fee. I don't know of any doctors who are billing Medicare for Sculptra itself and receiving payment. If anyone knows of any doctors who accept Medicare for coverage of Sculptra and injection fee, please let me know.

Most of our patients on Medicare qualify for the patient assistance program based on financial need and receive Sculptra from the company. So for these patients, the procedure fee is billed to Medicare as long as there is concomitant depression related to HIV lipoatrophy . The procedure payment amount from Medicare is meager (about $100) and very few doctors will treat at this rate. It has turned out that Medicare coverage of Sculptra was not much of a victory in that access to care remains limited.

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