Advertisement
Professionals >> Visit The Body PRO
The Body: The Complete HIV/AIDS Resource
Sign up for free e-mail updates!The Body en Espanol
Please Note: Due to volume considerations, not all questions can be answered. Questions most likely to be answered will be those of general interest to a broad group of visitors to this forum. Questions pertaining to a specific case; requests for diagnosis, medical advice, or second opinion; or requests for opinions about untested alternative therapies will generally not be answered.

Ask the Experts about Nutrition and Exercise
  • E-mail E-Mail
  • Glossary Glossary
Recent AnswersAsk a Question

 

sculptra insurance coverage
Jan 27, 2009

IN your blog in Nov '08, you gave a man advice on getting coverage from his insurance company for Sculptra treatments. you gave a diagnosis code of 272.6, but I could not find any mention of a PROCEDURE CODE......which my doctor's office says is required in order to file a claim with Medicare or any other insurer. The Sculptra reps were unable to help. Can you please tell me the procedure code to be used? Thank you.

Advertisement
   Response from Mr. Vergel

This is information provided to me by Dr Doug Mest, one of the pioneers in Los Angeles in the use of Sculptra. You may want to read about his work at http://www.bpacific.com/media/savingface.pdf and have your doctor contact him. This is an email he sent me to answer your question:

"As for which codes to use, therein lies one of the issues with Insurance billing and subsequent payment for the physician doing facial lipoatrophy treatments. No current CPT code accurately describes what we are doing and/or pays enough per session or allows the frequency of retreatment.

However, here are the available codes: 11952 injection of subcutaneous filler for 5-10 ccs 11954 for more than 10 ccs This is the most common CPT but pays very poorly.

The other code is 21138 that has been used. This pays more but can only be used every 90 days. So not really how we inject Radiesse, or Sculptra or even Silicone in this country.

Hope this help

Doug"

Reimbursement for Sculptra's labor is very limited and still evolving, unfortunately. A lot has to be done in activism to make this change, but I am afraid most people are too busy with their daily lives to think about helping not only themselves but others who are struggling with reimbursement issues and trying to find answers.

Stay tuned and hope that i get lucky to organize the first "Body Changes in HIV: Reimbursement and Advocacy Issues" Conference some time late summer if I get funding to do it and people who care to join me.

Nelson



Want to read more questions and answers on this subject? Our experts have answered many similar questions!



Terms of Use
Please remember that this forum is designed for educational purposes only, and experts are not engaged through this forum in rendering legal or medical advice or professional services. Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither The Body nor any sponsor is the publisher or speaker of posted visitors' questions or the experts' material.

Questions and messages posted to this forum are not statements of advice, opinion, or information of The Body, Body Health Resources Corporation or any sponsor of this forum. While neither The Body nor Body Health Resources Corporation regularly reviews posted content, we reserve the right to delete, move, or edit postings if we deem it appropriate under the circumstances. Visitors submitting questions remain solely responsible for the content of their messages.

Information provided by experts is general only and should not be used for diagnosing or treating a health problem or a disease, or relied upon as legal or other professional advice. This information is not a substitute for professional advice or care. If you have or suspect you may have a health or legal problem, you should consult your own health care provider or your attorney.

Copyright notice.

Advertisement