Q: Who can use cold cap therapy? What other resources are there for patients?

A: Many chemotherapy patients can use cold cap therapy, including all solid tumor patients. The specific drug treatment plan and various health factors will need to be considered. Generally, the first step is to consult with your physician. Cold cap websites can also be a good starting point, offering information about the process, how to order caps, and phone numbers for more detailed information.

There are some other resources for patients considering or using cold caps. 

Breastcancer.org has a number of existing chat rooms for cold cap users. Or you can start your own discussion. 

And the Chemotherapy Support Group on Facebook is a community forum. It’s a place to ask questions, offer advice and support each other.  Topics discussed in the group cover everything from drug regimens, ways of coping with chemo side-effects, to practical tips on capping.  Many members are using or have used cold caps. The group is hosted by Penguin Cold Caps but is not brand specific - all are welcome.

Another excellent support group for past, present and future cap users is Cold Cappers Support Group. Patients speak very highly of the knowledge and support they have received here.

Paxman Scalp Cooling has a patient-centric website, https://coldcap.com, which can help patients decide if this process is right for them, and which also offers extensive support and guidance along the capping journey. Paxman also has a Facebook support group for past, present and future users of the Paxman system. 




Q: Why cold caps?

A: Studies have shown that wearing a cold cap slows down the metabolic rate at which hair cells absorb nutrients or anything else in the blood like chemotherapy drugs. Further, the extremely cold cap temperature constricts the blood vessels leading to the hair follicles, reducing the amount of chemo drugs that reach the follicles while the caps are worn. As a result patients can save most of their hair (some thinning may occur). Of note, the drugs stay in the patient's system far longer, but reach the hair follicles when they are at somewhat diluted strength.


Q: Why is the freezer important?

A:  Cold caps can be cooled with dry ice, but dry ice is difficult to handle and uniform temperature control is problematic. A biomedical freezer keeps all caps ready at the correct temperature, continuously. Standard freezers do not get cold enough to get cold caps to their required temperature.

Q: Are the cold caps uncomfortable?

A: For about the first five minutes after each cap is put on, the sensation is quite cold. Warm blankets are helpful, and a shoulder massage seems to help as well. The discomfort dissipates after that, and the remaining 25 minutes of wear are comfortable to the point that one can hold a normal conversation or even play cards to pass the time.

Of note, even if a patient had chemotherapy without cold cap therapy, his/her body would feel cold because the saline being infused into the blood circulatory system is at ambient (room) temperature, not body temperature. This is why chemo clinics often supply blankets and patients are usually advised to wear sweaters.

Q: How difficult is it to learn to use the caps?

A: Practice makes perfect. We recommend a couple of dry runs with non-frozen caps at first. A minimum of one person assisting the patient is essential, and more than one is helpful but not critical. The patient's helper(s) need to keep track of time, keep the patient drinking water throughout the process, check the temperature of the new caps (especially if on dry ice and not in a freezer), swap out the old and new caps and straps, and keep the patient warm during the first five minutes of each cap application. As each complete cap change has to occur in less than two minutes, and the actual scalp exposure time between caps must be only a few seconds, everyone needs to know his/her job. Again, practice really helps.

Q: Are cold caps just for women?

A: Not at all. Cold cap therapy can be used by men, women and some older children.

Q: I’m about to undergo chemotherapy and my doctor hasn't mentioned cold cap therapy. Is it not widely available?

A: Because the first FDA clearance of a cold cap system just occurred in December 2015, many physicians still need to learn about the safety and effectiveness of this process, and many infusion centers do not yet have the equipment. However, with the approval of the patient's physician, individuals can rent a set of their own caps from cold cap providers and use them with dry ice if necessary. The Rapunzel Project is continuing to facilitate the use of cold caps by donating biomedical freezers to clinics, as they make cold cap therapy more manageable for more patients.


Q: What does cold cap therapy cost?

A: Costs will vary depending on the cap provider. Other factors affecting costs include the number of chemo sessions, or the number of months the caps will be in use.


Q: Is cold cap therapy covered by insurance?

A: As of 4/28/2017, Aetna has announced scalp cooling is medically necessary as a means to prevent hair loss during chemotherapy; it may be a covered expense provided that the member's individual plan includes it. 

In March 2018 an Aetna patient received 80% reimbursement for her manual cap rental fees. She reports using Diagnosis Code L65.9, Procedure Codes 97010, NCD110.9.

We had a previously confirmed reimbursement from Aetna as of 12/17. A cap user from Atlanta wrote “I just got my reimbursement check from Aetna for my cold caps!! I filled out the Medical Reimbursement Form, attached my itemized bill from Penguin and typed up a letter saying what all the equipment was and how it works (copied from Penguin website).  The code used was E1399 for durable medical equipment.  I didn't keep my receipts for dry ice since it wasn't covered then but I am thrilled to have my caps covered!!! The nurse case manager was super helpful in figuring this out with me.”

If you do not have Aetna, please check with your individual carrier. Note that even if cold cap therapy wasn't previously covered, plans and benefits are evolving now that 2 systems have been given FDA clearance. 

We also have a report (Jan 2018) of the first coverage approval for rented caps that we are aware of from United Health Care. The code that was successfully applied was again E1399 for durable medical equipment.

DigniCap has posted information on their website regarding medical insurance coverage for the use of their system. https://dignicap.com/insurance  It includes some helpful guidance in general for filing claims, as well as some useful coding suggestions. They state:

ICD codes on your claim form need to match your diagnosis exactly. These will likely be in the range of 0–C96.9 (Malignant neoplasm)
Suggested ICD diagnosis codes are:
Z51.11 (Antineoplastic chemotherapy)
L65.9 (Nonscarring hair loss unspecified, chemotherapy induced alopecia)

You may need to provide a CPT procedure or service code.

Effective 7/1/21 there are two newly approved CPT codes for mechanical (machine) scalp cooling. These will allow providers to bill insurers directly for these services. 

CPT® codes effective July 1, 2021

There is no unique CPT code for manual scalp cooling. Suggested CPT codes are:
97039 (Constant attendance) This code is also reported to be used by Blue Shield for Durable Medical Equipment
A9273 (Ice cap, cold wrap or pack)
A9282 (Wig any type, Cranial/scalp prosthesis) 

A 2017 patient received 80% reimbursement of her cap rental fees from Blue Cross of California. She reports they used code 704.00 for alopecia, and code A9282 for the cold caps (full cranial hair prosthesis). 

A 2016 patient advises that she submitted for reimbursement using a primary diagnosis code of L65.9 for a cranial prosthesis. This appears to be a new code - and she was told the info below is no longer current. However we are leaving it posted at this time in case it still has any usefulness. 

In 2014 we learned a patient was successful with insurance! The patient wrote:

I wanted to let you know that after denying my claim for cold caps, Anthem Blue Cross reversed themselves and paid. Below are the procedure and dx codes that did the trick. The first time they denied I called up and asked for the basis of the denial and checked what code they had used. They had changed the procedure code to an unspecified code and denied on that. My appeal was for them to process as the doctor had ordered. They did and paid ($1073 out of $1700 submitted). Please encourage others with and without Blue Cross to submit. Every time someone gets paid, it is a victory.

Cranial prosthesis A9282

dx alopecia for chemotherapy 704.00


We previously learned of a New York State employee whose insurance (through the state) did pay for about 85% of her cold cap rental expenses. Here's her story:

My oncologist's prescription stated that it was for a "Full Hair Prosthesis" for chemo induced alopecia, dx. code 179.9. When I telephoned my insurance company, they told me they would cover up to $1,500 for the cost of a wig.

After I completed chemo, I submitted the prescription, an invoice from MSC-Worldwide, and copies of my credit card statements showing the monthly fees I paid. (I submitted nothing about the deposit.) The insurance company first rejected my submission with no explanation code. I followed up by telephone and was told they rejected it because it was for a rental, not a purchase. I argued that no one told me about a rental exclusion etc. and they very nicely said that they would resubmit the claim, which much to my surprise, they then paid!

For further discussion of insurance coverage for cranial prostheses for chemo-induced hair loss, please read here.

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