January/February #169 : Losing Face Filler - by Tim Murphy

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Till Death Do Us Part

Southern Discomfort

Crash-Test Smarties

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Losing Face Filler

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January / February 2011

Losing Face Filler

by Tim Murphy

Medicare coverage of Sculptra and Radiesse fizzles.

Last March, HIV-positive people with facial lipoatrophy (loss of facial fat caused by HIV or the meds) rejoiced as Medicare announced it would reimburse doctors for injecting the fillers Sculptra and Radiesse. The news, it was hoped, would inspire more doctors to provide the treatment.

But Medicare set treatment reimbursement at a paltry $100 per visit (several are usually required), and most HIV doctors charge about $400 to $500 per visit for the procedure; non-HIV specialists charge up to $900. “The coverage is obviously a disappointment, and I doubt doctors will be flocking to provide this service,” says Gerald Pierone, MD, a Florida HIV doc who does the treatments. Doctors and patients also say regional Medicare contractors have not followed through on reimbursements and don’t seem to understand the new, required coding for them.

One HIV-positive man in Charleston, South Carolina, says Medicare has yet to reimburse  his doctor for “Round 1” of the treatment. “Almost five months after my first session,” he says, “the possibility of additional treatments, which might help me [have] a ‘normal’ appearance, is still up in the air.”

Medicare rep Ellen Griffith insists there was a public comment period before rates were set, but Nelson Vergel, an HIV-positive advocate on the issue in Houston, says, “They never showed us any proposed rates to comment on.” The rates aren’t up for revision until November 2011, but “an onslaught of letters to Medicare [7500 Security Blvd, Baltimore, MD 21244] from patients will help put the ball in motion,” says Doug Mest, MD, an HIV doctor in DC who does the procedures.
In the Meantime…
If your HIV doc doesn’t do the procedures or can’t refer you to one who does—and who accepts Medicare—go to medicare.gov, click “Facilities and Doctors” at left, then “Find a Doctor,” then search with the “Dermatology” specialty.

Once you find a Medicare-accepting doctor who’ll do the treatments, make sure he or she bills Medicare with this info:

1. A date of service (LIDOS) on or after March 23, 2010
2. A line with the HCPCS code Q2026 (Radiesse) or the HCPCS code Q2027 (Sculptra)
3. A line with the HCPCS code G0249 (dermal filler injection procedure)
4. The ICD-9-CM diagnosis codes 042 (HIV) and 272.6 (lipodystrophy)

If you hit a wall, contact Nelson Vergel via facialwasting.org. He’ll be gathering patient testimony to urge Medicare to revise coverage rates.

Search: Medicare, Sculptra, Radiesse, facial lipoatrophy, filler

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  comments 1 - 2 (of 2 total)    

Gary Youngblood, Dallas, TX, 2011-04-11 08:39:17
Why did Medicare team not analyze the cost of these treatments before setting rates? My take is that they never intended to cover in the first place - they just dangled hope in HIV peoples' faces, literally. The coding mess, reimbursement mess, and lack of doctors to perform the service due to low reimbursement and high cost to most who are in need make the current facial filler program useless as it is. I implore this process be reworked and some dignity be restored to the faces of HIV+'s.

Jeff Boone, New London, 2011-04-07 22:35:44
I have had fillers and saved for years and used credit cards to access this health care. It has changed my life. I had a skeleton face and had to wear padded underwear to ease the pain of simply sitting. Dare to do the right thing here! Jeff Boone

comments 1 - 2 (of 2 total)    

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