Is Sculptra PAP still available to Medicare patients?
Nov 11, 2011
Dr Pierone, In July 2010 I was able to get a local cosmetic surgeon to give me a single session of Sculptra injections as an "experiment" to see if Medicare would pay enough for him to be able to offer the service to other patients and to complete my treatment. When he finally received payment in Feb 2011 (after re-submitting the bill countless times)the amount paid did not even cover the price of the material, much less office expenses and, like every other private practice, he will not accept Medicare coverage for the procedure. I know the PAP for Sculptra has been scaled back, but can't seem to find out if it is available AT ALL to patients who are covered by Medicare. I am hoping I may be able to find another physician who would work with me if I can procure the filler itself through the PAP. Thanks for all your work here! Mike
Response from Dr. Pierone
We have Medicare patients who qualify for Sculptra through the PAP program. The eligibility of the PAP program is based on financial status, so many Medicare patients would be expected to qualify.
In Florida, we are able to get paid for the treatment session by Medicare if the patient has depression related to lipoatrophy. So we submit a charge to Medicare for the treatment, and a zero charge for the Sculptra itself since it was acquired from the access program. The Medicare payment is not very much (about $100) and does not cover office overhead so few doctors are providing this service.
I hope this information helps and best of luck!
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