Cold capping is not consistently covered by insurance, and most patients still pay out of pocket. However, the coverage landscape is shifting. Medicare now has a pathway for reimbursement through a local coverage determination, two states have passed laws requiring private insurers to cover it, and billing codes were updated in 2026 to support broader claims. Whether you’re covered depends on your insurer, your state, and the type of device used.
What Medicare Covers
Medicare has established limited coverage for scalp cooling through a local coverage determination (LCD). Under this policy, FDA-cleared scalp cooling devices are considered “reasonable and necessary” for patients with solid tumors undergoing chemotherapy. The key word is FDA-cleared: two systems currently meet that standard, the DigniCap (cleared in 2015) and the Paxman Scalp Cooling System (cleared in 2017). Manual cold caps, which patients handle themselves without a machine, are unregulated and explicitly excluded from Medicare coverage.
Medicare also lists several contraindications that disqualify coverage. These include blood cancers like leukemia and lymphoma, central nervous system tumors, skin cancers including melanoma, and conditions involving cold sensitivity such as cold agglutinin disease or cryoglobulinemia. Patients who have had or are scheduled for skull radiation are also excluded. If any of these apply, Medicare will deny the claim regardless of tumor type.
The billing infrastructure has also evolved. Scalp cooling previously used temporary Category III CPT codes (0662T and 0663T), which signaled experimental status to many insurers. As of January 2026, those codes were replaced with permanent codes 97007, 97008, and 97009. CMS treats the cooling cap itself as a supply that’s packaged into the payment for the chemotherapy session, meaning it isn’t billed separately from the professional or facility service. This shift from temporary to permanent codes is significant because it removes one of the technical barriers insurers have used to deny claims.
Private Insurance Coverage
Most private insurers do not cover cold capping as a standalone benefit. Aetna, for example, considers cooling caps “incidental to the chemotherapy administration” and does not reimburse for them separately. Under plans that exclude supplies, caps purchased by the patient are not covered at all. This framing is common across large commercial insurers: they treat scalp cooling as a convenience item rather than a medically necessary service.
That said, some patients have successfully gotten partial or full reimbursement by filing appeals, especially when their oncologist documents the psychological and quality-of-life impact of chemotherapy-induced hair loss. Success with appeals varies widely by plan and by employer. If your plan is self-funded (meaning your employer pays claims directly rather than buying a policy from an insurer), the employer has more flexibility to approve coverage on a case-by-case basis. It’s worth asking your benefits coordinator.
State Laws Mandating Coverage
New York and Louisiana are the first two states to pass laws requiring private insurers to cover scalp cooling. Both laws apply to large group insurance plans and cover both manual and automated cooling systems. If you’re insured through a large employer in either state, your plan is required to include this benefit.
These mandates don’t apply to self-funded employer plans (which are regulated at the federal level under ERISA, not by state law) or to Medicare and Medicaid. Still, the passage of these laws signals growing recognition that hair loss during chemotherapy is more than cosmetic, and similar legislation may follow in other states.
What Cold Capping Costs Without Coverage
The total cost of scalp cooling depends on how many chemotherapy cycles you need. Machine-based systems like Paxman and DigniCap typically charge per session, and a full course of treatment can run anywhere from $1,500 to $3,000 or more. Manual cold cap rentals from companies like Penguin Cold Caps can cost a similar amount when you factor in rental fees, dry ice, and shipping over multiple sessions.
Some cancer centers build the cost into their facility fees, while others require you to arrange and pay for the service separately. Before starting, ask your treatment center whether they have an in-house scalp cooling system and how billing is handled. If you’re paying out of pocket, the expense may qualify for reimbursement through a health savings account (HSA) or flexible spending account (FSA), though you should verify this with your plan administrator.
Financial Assistance Programs
HairToStay is a national nonprofit that provides subsidies of up to $1,500 to help cover cold cap treatment costs for patients who demonstrate financial need. Eligibility requires a solid tumor cancer diagnosis (blood cancers are excluded), full-time U.S. residency, and a household income at or below 600% of the federal poverty level. The organization has partnerships with specific treatment centers, including UCSF, so availability may depend on where you’re being treated. You can apply directly through their website.
Some treatment centers also have their own internal assistance programs or can connect you with local cancer support organizations that help offset costs. Your oncology social worker is typically the best person to ask about these resources.
How Effective Is Cold Capping?
Understanding success rates matters for the coverage question because insurers weigh clinical evidence when deciding what to reimburse. A meta-analysis found that patients who used scalp cooling had a 41% lower risk of hair loss compared to those who didn’t. Individual studies show success rates (defined as keeping at least half your hair) ranging from about 40% to 66%, depending on the chemotherapy regimen. Taxane-based regimens tend to respond better than anthracycline-based ones, and lower drug doses improve the odds.
These numbers mean cold capping works well for many patients but not all. The type of chemotherapy drugs, the dose, and how long the cap is worn before and after each infusion all influence the outcome. Even when it doesn’t prevent hair loss entirely, many patients retain enough hair to avoid needing a wig or head covering, which can have a meaningful impact on quality of life during treatment.
How to Improve Your Chances of Getting Covered
If you want to pursue insurance coverage, a few practical steps can help. First, confirm that your treatment center uses an FDA-cleared system (DigniCap or Paxman), since unregulated manual caps are much harder to get covered. Second, ask your oncologist to write a letter of medical necessity that addresses the psychological impact of hair loss, citing quality-of-life evidence and the National Comprehensive Cancer Network’s supportive care guidelines, which recommend scalp cooling. Third, request the specific billing codes (97007, 97008, 97009) from your provider’s billing department and submit a pre-authorization request before your first treatment.
If your initial claim is denied, file an appeal. Include your oncologist’s letter, the FDA clearance documentation for the device, and any relevant state mandates. Patients in New York and Louisiana have the strongest legal footing, but even in other states, a well-documented appeal can succeed, particularly with self-funded employer plans that have more discretion in their coverage decisions.