Patient Insurance Coverage

Boston Scientific, the manufacturer of SpaceOAR Hydrogel is devoted to partnering with healthcare professionals and patients to navigate today’s ever-changing health insurance system.

Does Medicare Cover and Reimburse for the SpaceOAR Hydrogel procedure?

To date, all 7 Medicare Administrative Contractors (MAC’s) do reimburse for the SpaceOAR procedure, based on medical necessity.

How can I find out if my insurance company will cover the SpaceOAR Hydrogel procedure?

From a national payer perspective, many private payers have formalized favorable coverage policies for SpaceOAR Hydrogel. In addition, we are seeing approvals on a case-by case basis with either a preauthorization or a voluntary predetermination with several other payers across the United States. In general, for every SpaceOAR Hydrogel 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 process is a crucial component to understand the coverage criteria under your plan. Your plan may require a Prior Authorization and/or allow for a voluntary Pre-Determination. These processes are meant to allow your health insurance company the opportunity to evaluate your treatment plan and specifics of the request to review for medical necessity. Please ask your doctor’s office about your anticipated coverage options.

Determining Your Costs and Coverage

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Is there a financial assistance program available for SpaceOAR Hydrogel?

There is no formal patient financial assistance program available for the SpaceOAR Hydrogel procedure at this time.

What if my health insurance company has denied coverage for the SpaceOAR procedure?

If your health insurance company has denied coverage for the SpaceOAR procedure, we recommend to formally appeal the decision by following these steps:

  1. Contact your provider’s office to request that they submit a formal appeal on your behalf.
  2. If your provider agrees to continue with the appeal, please ask the staff to contact the SpaceOAR Hydrogel Reimbursement Representative for further assistance and available resources.
  3. If you are willing to appeal the decision on your own, please contact the SpaceOAR Hydrogel reimbursement representative by calling this number: 952-930-6026 or filling out the form below.

Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

SpaceOAR Hydrogel is intended to temporarily position the anterior rectal wall away from the prostate during radiotherapy for prostate cancer and in creating this space it is the intent of SpaceOAR Hydrogel to reduce the radiation dose delivered to the anterior rectum.

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 talk to your doctor about the risks and benefits associated with SpaceOAR Hydrogel.

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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Content of this web site is for Informational Purposes only and does not constitute medical advice and should not be used for medical diagnoses. Boston Scientific strongly recommends that you consult with your physician on all matters pertaining to your health or to address any clinical/medical questions.

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