June 4, 2010

Medicare Codes for Facial Fillers Now Available

Healthcare Common Procedure Coding System (HCPCS) numbers have been assigned to two facial fillers for HIV-related lipoatrophy, which should make it easier for patients covered by Medicare to receive treatment. The new HCPCS codes were announced in an update from the Department of Health and Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) published May 21. 

HCPCS codes are assigned to every service a clinician may provide to a Medicare patient including medical, surgical and diagnostic services. The codes are used by Medicare and maintained by CMS to ensure uniformity. 

CMS announced March 23 that it will begin covering the cost of U.S. Food and Drug Administration (FDA)–approved facial wasting fillers—Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite)—for Medicare beneficiaries who are experiencing symptoms of depression related to the stigmatizing effects of lipoatrophy. Until recently, however, Medicare recipients with HIV-associated lipoatrophy have had difficulty accessing the facial fillers due to the fact that HCPCS codes had not yet been assigned to the treatments. 

The assigned HCPCS 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.

Search: Radiesse, Sculptra, lipoatrophy, CMS, Medicare, HCPCS, reimbursement

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Previous Comments:

Spence, New York, 2011-04-06 12:39:00
Hello All, I need to get a Sculptra touch-up. My doctor, Dr. Freshette, passed away and I don't know any doctors that accept medicare for scultra treatment. Please reply if you can recommend someone. I think I can qualify for the product through an assistance program Thanks for your time.

Ivan, Chicago, IL, 2011-03-22 14:39:46
I want to apply for assistant program to have Sculptra, my income taxes is about $30.000 a year, so I can get it, but I can't afford to pay $500.00 for doctor visit each time. is there anyone who knows a doctor who charge less? I'm in Chicago City. Than you!!!

Jim Kelley, Columbus, 2011-02-24 16:31:19
I have had this treatment done 2 years ago and it was awesome but VERY expensive for me on disability. Now that it says Medicare approves this, how can we let provider know? I am attempting to get treatment and they state Medicare says it doesn't cover this "cosmetic" procedure. Any help would be appreciated. I'm not giving up ;)

Jimbo, , 2010-08-16 19:50:02
I've been getting Sculptra through the compassionate use program. The cost of getting the actual injections,$350 per session for 8 sessions, however,is steep for someone on disability. How does Medicare really make the procedure any more affordable for people like me?

Karl Reed, Baton Rouge, 2010-06-18 15:02:11
I have been trying to get this procedure done and have not been able to get "pre-certified." Can anyone who has been succssful respond to let me know what to do. Thanks, Karl

friend, , 2010-06-09 17:18:19
Craig, I am also insured and one time I got my insurance company to pay for it. The secretary at my dr. office was great, but I still had to pay his fee which was huge. Then my Doc. stopped submitting to insurance and it had to be self pay. I am curious to see how this is going to work with the insurance companies. It would be very unfair not to cover this as well.

Craig, Orlando, 2010-06-09 16:32:12
Well first of all! It is about time!!! As for the comments about the medicare and what it is for as well as the free stuff. Well I dare any one of you to walk in my shoes for one week and see where you all stand as far as free! It is not free! I would rather have a full time job and have to work 50hrs a week for 40hrs pay ! Instead of trying to get the services that I am entitle to because of my illnesses. I worked for what money and benefits I get!

JJB, San Francisco, 2010-06-09 15:32:43
So now, when will Medicare cover lipodistrophy? My plastic surgeon has done 3 wonder procedures on my neck and back but doesn't get paid because Medicare calls it cosmetic. She never charged me but that doesn't sound fair that Medicare doesn't pay my surgeon. Duh!

Elizabeth, Lowell, MA, 2010-06-09 12:58:10
This a great news, but I do hope to know what dermatologist will accept this process, because I was turn down because I had no money although, I knew that medicare would pay for this process. Good job we all deserve to look real good. Thank You

Tim, Pompano Beach, FL, 2010-06-09 12:25:16
Medicare is not welfare John, it's a program for those over 65 or disabled due to illness (AIDS in this case). Clearly you have no understanding of how difficult it is to be deemed disabled, and you obviously do not know what you are talking about. Take your tea-party attitude somewhere else as it is offensive on this site.

Craig, Newark, NJ, 2010-06-09 11:14:32
So now, will standard insurers follow suit? Although I applaud Medicare coverage of this treatment, apparently, it is still unavailable to those who are insureed, but cannot afford the EXHORBITANT cost of treatment. That is VERY disheartning!!!

John, Washington D.C., 2010-06-04 14:12:34
I bet you people on welfare are so excited that the government is going to be giving you more free stuff. Must be nice to get everything on someone else's dime.