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Dealing with a Prostate Cancer Diagnosis

Insurance Update: Determining Your Costs and Coverage

Boston Scientific is pleased to announce that there is even greater access for SpaceOAR Hydrogel. The positive coverage by Medicare and other major insurers across the US allows for patients to include SpaceOAR with their radiation therapy for their prostate cancer.

Being diagnosed with prostate cancer can raise many unanswered questions about your health, treatment options, and side effects of the treatment you choose. There are many things to consider when making such decisions about your care including the financial aspect of your treatment. In the case of radiation, your medical team may offer the placement of SpaceOAR before radiation therapy which has been shown to help minimize the side effects by preserving the rectum. The financial burden that comes with a major life changing diagnosis can be just as challenging. It is important for the patient and the caregiver to be proactive in the treatment, care and prognosis and feel empowered to make an informed decision about their care.

As with any other procedure, the first step is to reach out to your health care provider to verify the coverage options under your specific plan. In general, for every SpaceOAR patient, we recommend that your provider perform a complete verification of benefits with your insurance company several days, if not weeks, in advance of the scheduled SpaceOAR procedure. The verification of benefits is a crucial component to understand the coverage criteria under your plan as well as timing the scheduling of your procedure.

There is a whole team behind SpaceOAR to help you navigate the insurance coverage of SpaceOAR in the event you encounter obstacles related to your insurance.

For more information visit: SpaceOAR Patient Insurance Coverage

1 Hamstra DA, Mariados N, Sylvester J, et al. Sexual quality of life following prostate intensity modulated radiation therapy (IMRT) with a rectal/prostate spacer: Secondary analysis of a phase 3 trial. Pract Radiat Oncol. 2018 Jan – Feb;8(1):e7-e15.

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As with any medical treatment, there are some risks involved with the use of SpaceOAR Hydrogel. Potential complications associated with SpaceOAR Hydrogel include, but are not limited to: pain associated with SpaceOAR Hydrogel injection; pain or discomfort associated with SpaceOAR Hydrogel; needle penetration of the bladder, prostate, rectal wall, rectum or urethra; injection of SpaceOAR Hydrogel into the bladder, prostate, rectal wall, rectum or urethra; local inflammatory reactions; infection; injection of air, fluid or SpaceOAR Hydrogel intravascularly; urinary retention; rectal mucosal damage, ulcers, necrosis; bleeding; and rectal urgency.

Please note: this coding information may include codes for procedures for which Boston Scientific currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of any Boston Scientific products for which they are not cleared or approved. The Health Care Provider (HCP) is solely responsible for selecting the site of service and treatment modalities appropriate for the patient based on medically appropriate needs of that patient and the independent medical judgement of the HCP.

Health economic and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently. Boston Scientific recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved label. Information included herein is current as of November 2018 but is subject to change without notice. Rates for services are effective January 1, 2019.

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
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