March 24, 2010
Medicare to Cover HIV-Related Facial Wasting Treatment
The Center for Medicare and Medicaid Services (CMS) announced March 23 that it will begin covering the cost of U.S. Food and Drug Administration (FDA)–approved facial wasting (lipoatrophy) treatments for Medicare beneficiaries who have facial lipoatrophy caused by antiretroviral drug use. Effective immediately, CMS will begin covering the cost of facial fillers for people living with HIV who are experiencing symptoms of depression related to the stigmatizing effects of lipoatrophy.
Lipoatrophy is a condition where fat just beneath the skin is lost over time. Lipoatrophy is a side effect caused primarily by the antiretroviral drugs Zerit (stavudine) and Retrovir (zidovudine). Though lipoatrophy can affect any part of the body, it is particularly noticeable and most often stigmatizing when it involves the face.
There are two temporary facial fillers for lipoatrophy: Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite). Both cost about $1,500 per application, and people may require treatment more than once per year, a recurrent expense many people with HIV cannot afford.
One of the documented consequences from facial lipoatrophy is depression, brought on because of the stigmatizing nature of facial fat loss. Several studies have shown that treating facial lipoatrophy reduces depressive symptoms in people with HIV.
CMS’s decision “marks an important milestone in Medicare’s coverage for HIV-infection therapies,” said the agency’s chief medical officer and director of its clinical standards and quality. “Helping people living with HIV improve their self-image and comply with anti-HIV treatment can lead to better quality of life and, ultimately, improve the quality of care that beneficiaries receive.”
Search: Medicare, Medicaid, CMS, lipoatrophy, facial wasting, coverage, facial filler, Zerit, stavudine, Retrovir, zidovudine, Sculptra, poly-L-lactic acid, Radiesse, calcium hydroxylapatite
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comments 1 - 15 (of 28 total) next
Adrian Raymond, Long Island City, NY, 2011-06-01 14:56:39
What has happened to Medicare coverage of administration of Sculptra and Radiesse passed on March 23, 2010? My doctor says he's received no medicare payment for eligible patients.
Dennis, Miami Beach, 2011-01-06 16:03:45
In Miami Beach do you know who is accepting medicare and medicaid por sculptra? please enlightning me. Have a great day?
Tim Horn, AIDSmeds, New York, NY, 2010-12-28 06:42:58
Leon, the assigned HCPCS (Medicare) code for Radiesse injections is Q2026, according to CMS. The assigned HCPCS code for Sculptra injections is Q2027. These codes are effective for claims with dates of service on or after March 23, 2010.
Leon, , 2010-12-27 14:10:58
My dermatologist hasn't been able to acquire Medicare's contact information specifically for facial wasting. (In other words, Medicare doesnt seem to know.) He would like to know the process involved in getting Medicare to pay for the treatments. He mentioned something about needing Medicare codes in order to get Medicare to pay for the process. I'm hoping that POZ or AIDSMEDS have specialists such as editors or journalists that can look into this. If not, whats the point of articles on this?
David/Houston, Houston, 2010-12-27 12:50:18
I have had sculptra and absolutely love the results. I did have 5 bottles in each cheek to get the result I desired, because my cheeks were very sunken in. My ex HIV Dr, went into skin care and he offered the program. Also plastic surgeon's offer the program as well, you just have to pick up the phone and be diligent. Both Sculptra and Radiesse offer the drug for free you just have to find the Dr to administor it. As long as you are Hiv and on disability and make less than $80.000.00 .
Vic George, williamstown mass, 2010-11-30 04:32:55
Yes! to find a Dr to perform this treat will take some leg work. However Medicare will not pick up any of this procedure.humm? Gives one false hope.It can be very costly! so what does one do?
Buddy, Houston, 2010-08-30 12:38:34
I had 3 Sculptra injections back in 2005. I had great results, but it took about 3 months for the full effect to show. I lasted for almost 3 yrs. I got it through the patient assistance program. Unfortunately it only covered the sculptra itself and the doctor visits were $275 each and I cant afford to get it done again.
Dwayne, BFE OKLAhoma, 2010-06-25 18:15:35
Called 20 numbers from sites. Been 4 months and still unable to find Dr. to do this procedure with MEDiCare. Sounds like great rainbows but U still get wet n left hung out to dry up.
dwayne, BFE, OKLahoma, 2010-05-26 17:34:25
Thanx Garrett I got around 20 numbers and called in Tulsa & OKC...Only 2-3 took Medicare told them about the article they said they would call by...WeLL He No they didn't. Figure I'm stuck looking like a crack meth Junky ! N tell those panhandlers at hotels I stay at because of business that ask if I have drugs For Sale to "Go F. Off". N tell the HIV Dr. a few words. I'm pissed n depressed. Who's got a Valium !!
Garrett, Stayton, OR, 2010-05-18 08:25:02
Hi Guys, for those of you who want to find a doctor; go to either www.sculptra.com or www.radiesse.com Both have a window you can type in your zip code to find a provider. Also check both, they may offer financial assistance to those who do not have insurance or insurance that may not cover the treatment. Hope this helps. Garrett
dwayne, BFE,OKlahoma, 2010-05-11 19:31:46
Seems to appear we the infected and those with this issue of facial wasting have to do all the foot work. No POZ staff, Doctor's, nurses, or any Medicare workers,places that provide these services have responded. Are not giving Us any information or follow up with this. Where is Hope ? And HeLp ??
dwayne, BfE, Oklahoma, 2010-05-11 19:26:00
The above artical states Radiesse is approved. I did find a Dr. that uses it and they called me back that another HIV person called asking about services. They siad sorry they can not help us out. As they don't know how to use Sculptra.I explained the useage of sculptra on myself and didn't care for it at all.They said there was a recall on it years back?? Anyone know maybe they have improved it.But in 05 and 06 it wouldn't last and after many months of injections continued 2 vanish notlast2yrs.
David, Arlington VA, 2010-04-29 12:47:10
The Director of my Northern Virginia HIV Clinic told me on the phone today that Sculptra has DEFINITELY been approved by Medicare for treatment of lipoatrophy/facial wasting. I am seeing my dermatologist next week for another matter and will discuss it with him. I will post here again once I find out what he says.
dwayne, bfe,Oklahoma, 2010-04-28 14:58:53
Zerit kept me healthy for 9yrs but it stole my fat, face, buttocks, muscles, and most of all my self esteem & self worth.Causing depression, low self esteem, worry of how others see view me. This all sounds great what were reading but Medicare denie these statements & don't have any info. about this nor any records on the above dated artical. 1 Dr said another HIV person approched them after I but they said "No" don't know how to do Scultura they do Radiesse but refused to do US. Afraid of HIV??
dwayne, bfe, OKLAhoma, 2010-04-28 14:42:15
comments 1 - 15 (of 28 total) next
I don't want Sculptra !Ive had it and in a week I looked back the same.Finally my mother told me yesterday 4/27 she didn't see any improvement with it either.It was to last 2yrs. I went in once a month and had injections hollows of cheeks n temples.Looked fine when he did it and took pics but in a week I was calling back saying I believe my body absorbed that water. Unless they have improved it was a waste n left me wishful thinking.Told me notta look n mirror ILookedForward4nextInjButDntLastLon
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