CPT 97007: Scalp Cooling Device Measurement, Fitting, Supply, and Education
CPT code 97007 captures the measurement, fitting, supply, and patient education for a scalp cooling device used across a chemotherapy treatment period. Nationally, this code matters as scalp cooling gains attention for its role in chemotherapy-induced alopecia prevention and for the administrative implications of billing a single-per-treatment-period service that includes both device provision and instructional counseling. The code is relevant to public and private payers managing coverage for supportive oncology services and durable medical equipment.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, typical clinical settings and workflows, and the types of benchmarks and policy considerations commonly examined for this service. The publication outlines common billing practice notes, payer coverage patterns, and where stakeholders often look for authorization and documentation guidance. It also provides clinical context on how the service integrates into chemotherapy care pathways and what claims administrators typically review when adjudicating a 97007 charge.
Data not available in the input for specific modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and payer-specific coverage policies.
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Billing Code Overview
CPT code 97007 describes the measurement, fitting, and provision of a scalp cooling device, including patient education about how scalp cooling works and what to expect. This procedure is reported once for an entire chemotherapy treatment period and reflects a bundled service encompassing device supply and instructional counseling.
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Service type: Medical device provision with patient education and fitting
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Typical site of service: Outpatient oncology clinic or infusion center
Clinical & Coding Specifications
Clinical Context
A 52-year-old woman with stage II invasive ductal carcinoma is scheduled to receive a multi-cycle cytotoxic chemotherapy regimen at an outpatient infusion center. Prior to her first chemotherapy session, a licensed clinician measures the patient’s head circumference, fits a medical-grade scalp cooling cap, instructs the patient on how the device works, discusses common sensations and expected timing for cap wear (pre‑ and post‑infusion cooling periods), and documents patient education and device supply. The cooling cap is supplied and fitted once for the entire chemotherapy course; subsequent infusions use the same device unless replacement is needed. Typical workflow includes pre-chemotherapy nursing assessment, cap fitting and education by a trained clinician (oncology nurse or certified medical fitter), documentation of the fit and instructions in the medical record, coordination with infusion scheduling for required pre-cool and post-cool times, and billing of 97007 once per chemotherapy treatment period.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is performed on the same day as cap fitting and is separately identifiable from the scalp cooling service |
59 | Distinct procedural service | Use when another procedure on the same day is separate and distinct from the scalp cooling fitting |
76 | Repeat procedure or service by same physician or other qualified health care professional | Use if the fitting procedure must be repeated during the same chemotherapy period due to device replacement and payer allows repeat reporting |
77 | Repeat procedure or service by another physician or other qualified health care professional | Use when a different provider repeats the fitting service for clinical reasons |
GA | Waiver of liability statement on file (Managed Medicare) | Use when informed consent or waiver requirements are met per payer policy |
GZ | Service expected to be denied as not reasonable and necessary | Use when documentation supports medical necessity but service lacks coverage and the provider expects denial |
KX | Requirements specified in the medical policy have been met | Use when payer requires documentation of meeting policy criteria for scalp cooling |
TC | Technical component | Use when reporting only the device supply/technical component and professional services are billed separately (rare for 97007) |
26 | Professional component | Use when only the professional component (education and fitting) is billed separate from the device supply |
52 | Reduced services | Use if the service rendered is partially reduced from the full descriptor and payer requires modifier |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
364S00000X | Oncology (Medical Oncology) | Medical oncologists order and coordinate chemotherapy and scalp cooling as part of supportive care |
363L00000X | Nursing (Oncology Nursing) | Oncology nurses perform measurements, fittings, and patient education in infusion clinics |
3336C0001X | Prosthetics/Orthotics (Medical Device Fitter) | Certified fitters or device specialists who supply and fit scalp cooling systems |
207K00000X | Dermatology | Dermatologists may be consulted for scalp conditions that affect cooling cap use |
208000000X | General Practice (Primary Care) | Primary care clinicians may document pre-treatment counseling and comorbid condition management |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Breast cancer is the most common indication for chemotherapy and use of scalp cooling to reduce chemotherapy-induced alopecia |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Same clinical relevance for left-sided breast cancers undergoing cytotoxic chemotherapy |
C80.1 | Malignant (primary) neoplasm, unspecified | Used when a specific site is not documented but chemotherapy is administered and scalp cooling is considered |
D61.0 | Drug-induced aplastic anemia | Reflects chemotherapy-related hematologic toxicity considerations that may affect overall treatment planning, not a direct indication for scalp cooling |
Z51.11 | Encounter for antineoplastic chemotherapy | Represents the encounter code for chemotherapy administration during which scalp cooling is used |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96413 | Chemotherapy administration, intravenous infusion, each additional hour (List separately in addition to primary infusion code) | Represents the chemotherapy infusion event during which scalp cooling is used; timing coordination needed for pre‑ and post‑cool periods |
96415 | Chemotherapy administration, intra-arterial; each additional hour | Alternative infusion administration code for non-IV routes where scalp cooling may still be applicable |
99070 | Supplies and materials provided by physician over and above those usually included with the office visit or procedure (e.g., surgical supplies) | May be used by some payers to report supplies if device supply is billed separately instead of including in 97007 (payer dependent) |
99401 | Preventive medicine counseling and/or risk factor reduction intervention, individual; approximately 15 minutes | Represents extended counseling time for device education if billed separately under appropriate circumstances |
99080 | Special reports such as insurance forms, more than standard documentation | Use when additional documentation is provided to payers demonstrating medical necessity or policy compliance |