CPT 97008: Scalp Cooling Assistance During Chemotherapy
CPT code 97008 covers provider-assisted scalp cooling performed at the start of a chemotherapy session. This adjunctive oncology service involves preparing the patient’s hair, positioning the cooling cap, initiating the cooling system, and commencing the precooling period before chemotherapy infusion. The code is reported once per chemotherapy session and is relevant for facilities that offer hair-preservation techniques to mitigate chemotherapy-induced alopecia.
Key national payers relevant to CPT code 97008 include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and payment policies vary across carriers and plan types, and the service typically occurs in hospital outpatient infusion centers, ambulatory infusion centers, and oncology clinics.
Readers will find an overview of the clinical context for scalp cooling, the service setting, and how this code is used in billing workflows. The publication summarizes benchmark considerations, common documentation elements needed to support the service, and any recent policy developments or coding guidance that affect how CPT code 97008 is reported and reviewed by payers. Data not available in the input for specific payer policies, payment amounts, modifiers, and claim adjudication patterns is noted within the report.
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Billing Code Overview
CPT code 97008 describes a provider-assisted scalp cooling service performed during a chemotherapy session. The service includes preparing the patient's hair, placing the cooling cap, initiating the cooling device, and starting the precooling period before chemotherapy begins. Report CPT code 97008 one time per chemotherapy session.
Service type: Supportive oncology/adjunctive service during chemotherapy infusion
Typical site of service: Hospital outpatient infusion center, ambulatory infusion center, or oncology clinic
Data not available in the input for payers, common modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 54-year-old woman with stage II invasive ductal breast carcinoma is scheduled for her third outpatient infusion of an alopecia-inducing chemotherapy regimen (e.g., docetaxel and cyclophosphamide). Prior to each chemotherapy infusion, a trained oncology nurse prepares the patient for scalp cooling to reduce chemotherapy-related hair loss. The workflow begins with verifying the physician order for scalp cooling and confirming contraindications (e.g., known scalp metastases). The nurse explains the scalp cooling process, assists with shampooing or detangling as needed, measures the patient’s head circumference for proper cap sizing, and places the prechilling cap system. The nurse initiates the cooling device and monitors the precooling period required before infusion start. Once target scalp temperature is achieved and the cap is secured, chemotherapy infusion begins. The scalp cooling cap remains in place and the cooling continues during infusion and the post-infusion cooling period per device protocol. Billing uses 97008 reported once per chemotherapy session for the provider’s assistance with scalp cooling setup and initiation.
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 | When a separate E/M visit is provided the same day as scalp cooling setup and meets E/M documentation requirements. |
59 | Distinct procedural service | When scalp cooling setup is a distinct service separate from an infusion administration code and documentation supports separation. |
76 | Repeat procedure or service by same provider | When the scalp cooling setup is repeated during the same day by the same provider (rare). |
77 | Repeat procedure by another provider | When a different provider repeats the scalp cooling setup the same day. |
91 | Repeat clinical diagnostic laboratory test | Not typically used for this service; included for context when monitoring labs are repeated (uncommon association). |
GT | Telehealth via interactive audio and video | When remote supervision or telehealth coordination of scalp cooling is performed (limited applicability). |
Q0 | Investigational clinical service furnished under a clinical research protocol | When scalp cooling is provided as part of an approved clinical trial requiring this modifier. |
Q2 | Services furnished under a research protocol, not investigational | When provided under non-investigational research agreements that require this reporting. |
KX | Requirements specified in the medical policy have been met | When payer-specific prerequisites for coverage of scalp cooling are documented and required by the insurer. |
GA | Waiver of liability statement on file (no ABN) | When the provider has a signed advance notice of noncoverage for the scalp cooling service. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208000000X | Medical Oncology | Oncologists order and oversee chemotherapy and scalp cooling decisions. |
| 363L00000X | Infusion Nursing | Nurses who prepare and place scalp cooling systems in infusion centers. |
| 207Q00000X | Hematology/Oncology | Hematology/Oncology specialists managing systemic therapy that requires scalp cooling. |
| 367A00000X | Oncology Nursing | Oncology-certified nurses who conduct patient education and device initiation. |
| 251B00000X | Clinical Nurse Specialist | Advanced practice nursing roles in oncology infusion clinics managing protocols. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.912 | Malignant neoplasm of unspecified site of right female breast | Breast cancer patients frequently receive alopecia-inducing chemotherapy and may elect scalp cooling. |
C50.911 | Malignant neoplasm of unspecified site of left female breast | As above, applicable to patients with left-sided breast malignancy undergoing chemotherapy. |
C79.81 | Secondary malignant neoplasm of brain and cerebral meninges | Contraindication consideration: presence of scalp or cranial metastases may alter scalp cooling candidacy; documentation required. |
Z51.11 | Encounter for antineoplastic chemotherapy | Denotes encounter for chemotherapy infusion during which scalp cooling is provided; links the service to therapy. |
D61.9 | Aplastic anemia, unspecified | Example of hematologic conditions receiving chemotherapy; included as a less common oncology diagnosis associated with infusion treatments. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96413 | Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug | Represents the chemotherapy infusion session during which 97008 scalp cooling setup is performed; billed separately for drug administration. |
96415 | Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary infusion) | Billed when infusion extends beyond the initial hour; scalp cooling may continue during extended infusion. |
99211 | Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician | Low-level nursing or clinical visit on the day of infusion; used if an E/M service is documented in addition to scalp cooling setup. |
99406 | Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes | Not directly related therapeutically but may be delivered in the oncology setting alongside infusion services (example of ancillary counseling services). |
97032 | Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes | Represents other physical modality CPT examples used in oncology clinics; not typically billed with scalp cooling but included as ancillary modality code example. |