Re: Medicare paying for Sculptra

[Guest guest]

Tim here in Albuquerque.

I am no longer eligible to receive free comps of sculptra and am told

its cost can be covered by medicare? I had my doc's office submit the

paperwork and was informed it is not covered by medicare.

I am thinking there is more I can do here on my own w/ better results.

I desire to keep going forward w/ this and am wondering if any of you

out there have any experience or suggestions for me?

Thank you-all in advance for any assistance or ideas concerning this.

In appreciation,

Tim in Abq

[Guest guest]

Dear Tim -- Medicare does indeed pay for Sculptra treatments. Unfortunately, the reimbursement rate they've set is so low that basically no doctor is willing to participate, because they end up losing money. (Mcare does not even cover the actual cost of the material, much less realistic office expenses.) That being said, if your doc is willing to do it, make sure he/she or their billing manager have all the correct coding. I was able to get a doc to provide 1 treatment as an 'experiment' shortly after CMS issued the decision providing coverage, but his office manager had to re-submit the bill about 12 times before finally receiving payment. Persistence is the key. (Also, be sure your medical records document signs of depression related to your appearance.)

The proper codes can be found athttp://www3.cms.gov/transmittals/downloads/R122NCD.pdf'>http://www3.cms.gov/transmittals/downloads/R122NCD.pdf andhttp://www3.cms. gov/transmittals/downloads/R1978CP.pdfPrint out the pdf's and hand them to your doc.Good luck!!!Mike

[Guest guest]

You know I have had quite a few treatments with Sculptra. I am not really all that pleased with the product. It does not last and will leave you face full of nodules and lumps. It's a shame what they put us through in order to give us some selfesteem back into our lives. I am seeking a more permanent solution perhaps with another filler. I am interested if other fillers would be accepted by Medicare, considering the coding were correct. I am so tired of the money that I have to spend out of pocket to fight this disease and its consequences .. simply because of the ignorance and greed of others.

From: Mmmichael <mmmikeymike@...> " " < > Sent: Thursday, January 5, 2012 4:40 PM Subject: Re: Medicare paying for Sculptra

Dear Tim -- Medicare does indeed pay for Sculptra treatments. Unfortunately, the reimbursement rate they've set is so low that basically no doctor is willing to participate, because they end up losing money. (Mcare does not even cover the actual cost of the material, much less realistic office expenses.) That being said, if your doc is willing to do it, make sure he/she or their billing manager have all the correct coding. I was able to get a doc to provide 1 treatment as an 'experiment' shortly after CMS issued the decision providing coverage, but his office manager had to re-submit the bill about 12 times before finally receiving payment. Persistence is the key. (Also, be sure your medical records document signs of depression related to your

appearance.)

The proper codes can be found athttp://www3.cms.gov/transmittals/downloads/R122NCD.pdf'>http://www3.cms.gov/transmittals/downloads/R122NCD.pdf andhttp://www3.cms. gov/transmittals/downloads/R1978CP.pdfPrint out the pdf's and hand them to your doc.Good luck!!!Mike