Does Medicare cover HIFU? Here is what Traditional Medicare covers, what it does not, and what that means for your out-of-pocket costs with Dr. Stephen Scionti.
Two separate fees
For the HIFU procedure there are two separate fees: what you pay to Scionti Prostate Center for Dr. Scionti's professional fees, and what is paid to the facility for the hospital and anesthesia fees. Dr. Scionti performs HIFU at Lakewood Ranch Medical Center.
What Traditional Medicare (Part B) covers
Hospital and anesthesia services associated with HIFU treatment are covered for patients with Traditional Medicare (Part B) with no authorization needed. Deductibles, copayments or coinsurance may apply. Any supplemental coverage should also be reviewed.
What Medicare does not cover
Scionti Prostate Center welcomes patients with Medicare. Dr. Scionti has opted out of the Medicare program, and payment for his professional services is by private arrangement and is not covered by Medicare.
What about Medicare Advantage?
If you have Medicare Advantage or commercial insurance, there may be coverage for the facility and anesthesia fees, depending on your specific policy. Once Dr. Scionti has reviewed your medical records and qualified you as a candidate for HIFU, our office can connect you with our specialty team to discuss your insurance benefits and coverage. If required and permitted under your specific insurance policy, we will assist with obtaining prior authorization for the procedure.
Please note that obtaining authorization does not guarantee payment or coverage. Ultimately, your insurance company determines whether the HIFU procedure is covered under your individual policy and what portion, if any, will be covered. For more detail, see Is HIFU Covered by Insurance?
A billing code is only part of the answer
An insurer saying that a procedure code is "valid and billable," or that "no authorization is required," does not by itself establish that your treatment will be paid for. Ask for a patient-specific coverage determination when available and clarification of your financial responsibility. Prior authorization, when required, is an important step, but is not an unconditional guarantee of payment.
Follow-up care
Your HIFU fee includes follow-up care for 90 days post treatment. Annual follow-up visits in person or via telehealth are encouraged. There are professional fees for any appointments beyond the 90 days, and our team is happy to review this with patients prior to scheduling.
Find out whether HIFU is an option for you
Contact Scionti Prostate Center to begin a case review and discuss insurance coverage. Have your insurance information, biopsy report, PSA history and prostate MRI information available. Our team can explain how to submit records and next steps.
Call 866-866-8967 or request a HIFU case review.
Coverage and costs depend on your benefits, clinical circumstances and the services provided. Confirm your written estimate and coverage details before scheduling treatment.
