2026 Medicare Physician Fee Schedule Rates Set for Scalp Cooling CPT Codes
This is the first time scalp cooling has been included in the Medicare Physician Fee Schedule, marking a critical step forward in establishing consistent reimbursement.
'This decision is important for patients suffering from hair loss, a devastating and visible side effect of chemotherapy,' said Kate Dilligan, Founder and CEO of Cooler Heads. 'These new codes and proposed rates are a positive step towards helping all patients undergoing treatment for solid tumor cancers preserve their identity during treatment.'
CMS has proposed payment rates for three new CPT® codes related to mechanical scalp cooling. The first code, covering the initial fitting of the scalp cooling cap and patient education, would be reimbursed at $1,701. The second code, for the pre-infusion cooling period, is proposed at $10 per treatment. The third code, covering the post-infusion cooling period in 30-minute increments, would be reimbursed at $6 per unit.
The new codes do not apply to manual cold caps, highlighting the importance of FDA-cleared mechanical scalp cooling systems like Amma™. This decision also sets a precedent for private insurers to develop their own coverage policies, increasing the likelihood of broader access to patients.
After the public comment period concludes on September 12, 2025, and any subsequent updates are made, CMS is expected to release the Final Rule in November 2025. The revised Medicare Physician Fee Schedule (MPFS) rates and updated CPT codes will take effect on January 1, 2026. This timeline presents an exciting opportunity for Cooler Heads to collaborate with health systems.
Contact:press@coolerheads.com
About Cooler Heads:
Cooler Heads, based in San Diego, provides evidence-based products, content, and services that cancer patients need to manage the challenging side effects of treatment. Founded by a cancer survivor, Cooler Heads is driven by the mission to reduce the physical and emotional toll of cancer treatment, offering tools like Amma to improve the quality of life for patients.
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