If You Have Medical Insurance:
Learn About our Medicare Elite Access HIFU and TULSA Programs
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 Elite Access TULSA Program
The Scionti Prostate Center welcomes Medicare patients who chose TULSA-Pro for prostate cancer treatment. CPT Code, 55882, enables Medicare reimbursement of hospital outpatient facility costs.
Elite Access Program Overview:
- TULSA procedure is performed at BayCare Hospital Wesley Chapel in Westley Chapel, FL. We expect the Florida Medicare carrier to pay the hospital charges for the TULSA-Pro procedure. This groundbreaking program is one of the few TULSA programs in the USA.
- 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 professional care team as you undergo treatment.
- Our staff can assist you with Financing non-covered costs.
- Precision MRI Guided TULSA treatment personalized for your prostate cancer characteristics, performed by one of the most experienced TULSA-Pro physicians in the United States.
- Personalized Post TULSA care plan detailing follow-up, PSA testing, MRI monitoring, diet, lifestyle, and nutritional supplement recommendations.
Medicare-approved HIFU CPT code, 55880 and TULSA CPT code, 55882, 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.
TULSA CPT Code 55882 - Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducers for delivery of the thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed by a single physician.
Costs associated with HIFU and TULSA treatments:
When a man undergoes HIFU or TULSA, 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 or TULSA with the Scionti Prostate Center, this includes:
- For HIFU, the facility, Lakewood Ranch Medical Center, where the procedure takes place, is reimbursed by Medicare.
- For TULSA, the facility, BayCare Hospital Wesley Chapel, 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 are included in the 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 and TULSA treatment facilities if the procedure is performed at a hospital-based outpatient surgery facility like our center at Lakewood Ranch Medical Center and BayCare Hospital Wesley Chapel.
- 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 and TULSA procedure fees reimbursed by Medicare significantly reduce the out-of-pocket expenses paid by patients who undergo HIFU or TULSA treatments.
- 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, non-Medicare, or Medicare Advantage 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 or TULSA treatments, many patients have received partial and sometimes, even total reimbursement on appeal after the procedure has been completed. For patients who do not have insurance coverage, average HIFU out-of -pocket costs are $26,000, which includes all physician fees, anesthesia, treatment facility, and outpatient hospital fees.
For TULSA patients, the average out-of-pocket costs are $32,500, which includes all physician fees, anesthesia, treatment facility, and outpatient hospital fees.
Our Concierge program at Scionti Prostate Center will work with you to minimize out-of-pocket costs once you are determined to be a good candidate and have made a decision to have treatment.
- The Scionti Prostate Center will request pre-authorization for reimbursement for your HIFU or TULSA procedure as part of our concierge service prior to your HIFU or TULSA treatment.
- If your medical insurance carrier denies coverage, our team will provide you with an itemized receipt that you can use to attempt reimbursement by your health insurance carrier after your treatment.
- Although there are no guarantees, many of our patients have been able to recover some or even most of their out-of-pocket costs for their HIFU or TULSA procedures through this process.
Financing your HIFU Treatment
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