If You Have Medical Insurance:
Learn About our Medicare Elite Access HIFU Program
Medicare Elite Access HIFU Program
The Scionti Prostate Center welcomes Medicare patients who chose HIFU for prostate cancer treatment. CPT Code, 55880, enables Medicare reimbursement of hospital outpatient facility costs.
Elite Access Program Overview:
- HIFU procedure is performed at Lakewood Ranch Medical Center in Lakewood Ranch, The Florida Medicare carrier has paid the hospital charges in every single case over the past year. This program is the most successful Medicare HIFU program in the USA with well over hundreds of Medicare patients treated.
- Consultation with Dr. Scionti to develop a personalized treatment pathway for your prostate cancer that provides effective cancer treatment while maintaining your quality of life
- Personal access to Dr. Scionti and his HIFU care team as you undergo treatment.
- Our staff can assist you with Financing non-covered costs.
- Precision MRI Fusion Guided HIFU treatment personalized for your prostate cancer characteristics performed by the most experienced HIFU physician in the United States.
- Personalized Post HIFU care plan detailing follow-up, PSA testing, MRI monitoring, diet, lifestyle and nutritional supplement recommendations.
Medicare-approved CPT code, 55880, will allow hospital outpatient facility reimbursement for hospital costs.
HIFU has been assigned CPT Code 55880: Ablation of prostate, transrectal, high intensity focused ultrasound (HIFU), including imaging guidance. CPT Code 55880 became effective Jan 1, 2021.
Costs associated with HIFU treatment:
When a man undergoes HIFU, much like other medical procedures, there are a variety of healthcare providers providing services in order to carry out the treatment. When you choose HIFU with the Scionti Prostate Center, this includes:
- The facility (Lakewood Ranch Medical Center), where the procedure takes place, is reimbursed by Medicare.
- Anesthesia professional services are reimbursed by Medicare
- Technical support services as well as all supplies necessary, including the rectal wall cooling circuit are included in facility Medicare reimbursement
- Dr. Scionti's professional services, as well as Concierge Patient Support Services, are not reimbursed by Medicare as Dr. Scionti has opted out of the Medicare program.
Important summary information:
- Medicare WILL reimburse the fees for use of the HIFU treatment facility if the procedure is performed at a hospital-based outpatient surgery center like our Center at Lakewood Ranch Medical Center. Reimbursement has been very reliable and my Medicare patients can fully expect that the Hospital fees will be paid by Medicare.
- Medicare will NOT reimburse the professional & concierge patient fees paid to the Scionti Prostate Center as the Scionti Prostate Center does not accept Medicare reimbursement.
- This is good news as a portion of the total HIFU procedure fee is reimbursed by Medicare significantly reducing the out-of-pocket expenses paid by patients who undergo HIFU treatment.
- The care team at The Scionti Prostate Center will work with you to minimize your out-of-pocket costs.
Commercial or Non-Medicare Insurance
If you have commercial or non-Medicare Insurance: The Scionti Prostate Center - Insurance Reimbursement Assistance Program can help you get reimbursed.
Although it is still uncommon for commercial insurers such as Blue Cross, Aetna, United or Cigna to automatically reimburse HIFU treatment, many patients have received partial and sometimes, even total reimbursement on appeal after the procedure has been completed. Several VA patients have been reimbursed by the VA after their HIFU treatment. Our global, all-inclusive fee, for HIFU treatment is $25,000 which includes all physicians fees, anesthesia, treatment facility, use of HIFU equipment, HIFU equipment engineer, supplies and personalized concierge services.
The Concierge HIFU program in conjunction with Scionti Prostate Center will work with you to find a way for you to have HIFU treatment once you are determined to be a good candidate and have made a decision to have treatment.
- Scionti Prostate Center in conjunction will request pre-authorization for reimbursement of your HIFU procedure as part of our concierge service prior to your HIFU treatment
- If your medical insurance carrier denies coverage, the team will file your claim for reimbursement to your health insurance carrier after your treatment and will work with you to appeal any denials for reimbursement as part of our concierge services at no additional charge to you.
- Although there are no guarantees, we are very optimistic that many of our patients will be able to recover some or even most of their costs for their HIFU procedure through this process.
Financing your HIFU Treatment
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