If you have Medicare Insurance: Learn about our Medicare Elite Access HIFU Program
Medicare Elite Access HIFU Program
The Scionti Prostate Center , in conjunction with Vituro Health, welcomes Medicare patients who chose HIFU for prostate cancer treatment.
Elite Access Program Overview:
- HIFU procedure is performed at Lakewood Ranch Medical Center in Lakewood Ranch, Florida and The Medicare C- Code will be filed for reimbursement. If Medicare reimburses the facility fee, Medicare patient final out of pocket costs are estimated to be $10,000 to $12,000.
- 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 as you receive treatment and recover from your treatment
- Dr. Scionti and the staff from The Scionti Prostate Center in partnership with staff from Vituro Health, will work with you to maximize Medicare reimbursement for your HIFU treatment and minimize your out of pocket costs
- 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 expereinced HIFU physician in the United States.
- Personalized Post HIFU Handbook providing a care plan detailing follow up, PSA testing, MRI monitoring, diet , lifestyle and nutritional supplement recommendations.
Medicare approved a temporary facility or "C - code" in July 2017.
To read our latest Blog on Medicare reimbursement, please click here
HIFU has been assigned HCPCS C-Code C9747, Ablation of prostate, transrectal, high intensity focused ultrasound (HIFU), including imaging guidance C9747 became effective July 1, 2017
C-codes are unique temporary pricing codes established by CMS (Center for Medicare and Medicaid Services) that apply only to hospital outpatient surgery center and ambulatory surgery center (ASC) settings. The C-code does not apply to the office based outpatient surgery center or to physician services. Please note that there are NO codes for payment of the HIFU doctor’s fees or of the Anesthesia doctor’s fees as of the time of this writing.
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 and Vituro Health, this includes:
- The facility (hospital, outpatient facility etc.) where the procedure takes place. May be reimbursed by Medicare
- The specialist physician who performs the HIFU procedure.
- The anesthesiologist who administers anesthesia
- The engineer who provides technical support for the HIFU equipment
- All supplies necessary including the rectal wall cooling circuit
- Concierge Patient Support Services
Each of these above services has a specific cost associated with it.
- Medicare may reimburse the fees for use of the HIFU treatment facility if the procedure is performed at a hospital based outpatient surgery center or free standing ASC (ambulatory surgery center). Reimbursement has been sporadic and cannot be assured. Be aware of claims made by other centers that guarantee Medicare reimbursement as these claims may be misleading. Reimbursement is up to the Medicare carrier and is NOT determined by the HIFU services provider.
- Medicare will NOT reimburse the professional fees paid to the HIFU providers (doctors, anesthesiologists) as there is not a CPT code that is recognized by Medicare at this time
- This is good news as a portion of the total HIFU procedure fee may be 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 and Vituro Health will work with you to seek Medicare reimbursement whenever possible and can provide you with more personalized information as to your chances of Medicare reimbursement.
Commercial or Non Medicare insurance:
If you have commercial or non-Medicare Insurance: The Scionti Prostate Center / Vituro Health 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 Vituro Health 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 with Vituro Health 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 Vituro Health 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
Financing is available through our partner Prosper!
Prosper Healthcare Lending is the premier financing company in the healthcare industry. With over $5 Billion borrowed and over 250,000 people empowered, this is a name and a program you can trust.
Here are some of the benefits you’ll receive with a loan from Prosper Healthcare Lending:
- Immediate decisions without affecting your credit!
- Longer terms for lower monthly payments
- No collateral required
- No prepayment penalties
- Fast & easy loan inquiry process
- 100% Confidential
- Many patients choose to finance a portion or even 100% of their HIFU or E.D. treatment.