CommercialCoverageMedium impact
Scalp Cooling (Hypothermia) to Prevent Hair Loss During Chemotherapy (CPB 0290, reviewed 2026-06-08)
Aetna·Oncology, Hematology, Radiation Oncology +1 more·Medical Policy
Effective date
Jun 8, 2026
We identified it
Aug 16, 2026
Summary
Aetna has affirmed coverage for scalp cooling (hypothermia) to prevent chemotherapy-induced hair loss, covering three specific CPT codes (97007, 97008, 97009) for patients with malignant neoplasms and related conditions. This policy clarifies that mechanical scalp cooling devices are medically necessary and establishes specific billing codes for the service, requiring billing teams to recognize these codes for eligible cancer patients undergoing chemotherapy.
Action Required
By June 8, 2026: Billing team must update billing system to recognize and process CPT codes 97007 (mechanical scalp cooling with cap supply, measurement, fitting, and education), 97008 (scalp cooling with hair prep, cap placement, therapy initiation, and precooling), and 97009 (scalp cooling continuation after chemotherapy discontinuation, per 30 minutes). Implement verification logic to ensure claims for these codes include at least one qualifying ICD-10 diagnosis code from the covered malignant neoplasm range (C00.0-D49.89 per policy). Update encounter forms and provider education materials to include scalp cooling as a covered benefit for eligible oncology patients. Flag claims without qualifying diagnosis codes for denial. Coordinate with oncology, hematology, and related practices to ensure providers understand coverage criteria and documentation requirements.