NY Medicaid Covers Scalp Cooling in Landmark Health Equity Move

NEW YORK, NY – April 06, 2026 – For thousands of New Yorkers navigating cancer treatment on Medicaid, one of chemotherapy’s most dreaded side effects may no longer be a certainty. In a landmark decision for health equity, New York Medicaid has officially begun covering mechanical scalp cooling, a clinically proven therapy to reduce chemotherapy-induced hair loss. The policy, which went into effect on April 1, 2026, promises to dramatically expand access for some of the state's most vulnerable patients to a treatment previously reserved for those who could afford to pay thousands of dollars out-of-pocket.

The decision was highlighted in a recent announcement from Cooler Heads, a San Diego-based company that develops solutions for managing cancer treatment side effects, including its FDA-cleared Amma™ System. By adding specific CPT codes for the service to its fee schedule, New York is formally recognizing the procedure as a medical necessity, paving the way for broader adoption in oncology centers across the state.

Dismantling a Financial Barrier to Dignity

Chemotherapy-induced alopecia, or hair loss, is consistently ranked by patients as one of the most distressing and traumatic side effects of their treatment. More than a cosmetic issue, the loss of hair serves as a constant, public-facing symbol of illness that can profoundly impact a person’s self-image, privacy, and psychological well-being. Scalp cooling offers a way to mitigate this, but its benefits have long been out of reach for many.

Historically, the therapy has come with a prohibitive price tag, with out-of-pocket costs ranging from $1,500 to over $5,000 per patient for a full course of chemotherapy. This cost has created a stark divide in cancer care, where only patients with significant financial resources could access a tool that helps preserve their sense of normalcy and identity. New York's Medicaid coverage directly confronts this inequity, affirming that supportive care measures are not luxuries but essential components of a comprehensive and humane treatment plan.

"Our consistent commitment from day one has been to make scalp cooling accessible to all patients," said Kate Dilligan, CEO of Cooler Heads, in the company's announcement. As a cancer survivor herself, she understands the deep-seated need for this access. "Having been a patient myself, I know first hand how important it is to feel as normal as possible going through a health crisis. I am so excited that New York is making this therapy available to patients for whom this would have been out of reach."

How the New Coverage Works

The foundation of this new coverage lies in three specific Category I Current Procedural Terminology (CPT) codes established by the American Medical Association (AMA), effective January 1, 2026. The creation of these permanent codes signaled a formal recognition of scalp cooling as a standard, evidence-based medical procedure, providing a clear and consistent framework for billing and reimbursement.

The codes break the service down into distinct components:

• CPT 97007: This code covers the initial session, which includes measuring and fitting the patient with a custom cooling cap, as well as providing crucial education on the process and hair care during treatment. It is billed once per course of chemotherapy.
• CPT 97008: Billed with each chemotherapy infusion, this code covers the pre-infusion phase, including hair preparation, cap placement, and the initial cooling period that begins before the chemotherapy drugs are administered.
• CPT 97009: This is an add-on code used for the post-infusion cooling period, billed in 30-minute increments. This continued cooling is critical for the therapy's effectiveness.

For providers, this standardized coding provides the financial predictability needed to invest in the necessary equipment and staff training. While specific reimbursement rates vary, federal Medicare payment schedules for 2026 value the initial fitting and education service (97007) at approximately $1,883, underscoring the recognized clinical importance and resource requirements of the therapy.

A Ripple Effect: New York Sets a National Precedent

New York's Medicaid decision is not happening in a vacuum. It follows the state's pioneering legislation that took effect on January 1, 2026, mandating that most large group private health insurance plans also cover scalp cooling. By extending this coverage to its Medicaid population, New York has created one of the most comprehensive access environments for supportive cancer care in the nation.

This dual-pronged approach is expected to have a significant ripple effect, serving as a powerful model for other states to follow. As the largest and most complex healthcare systems demonstrate the feasibility and importance of covering scalp cooling, the pressure on other state Medicaid programs and commercial payers nationwide is likely to increase.

The move also energizes the competitive market for scalp cooling technology. While Cooler Heads and its Amma™ System stand to benefit, the coverage applies to all FDA-cleared mechanical scalp cooling systems, including those from major players like Paxman, which recently merged with its competitor Dignitana. This broad reimbursement pathway incentivizes innovation and market penetration across the board, ultimately benefiting patients with more options and wider availability.

Laurie Sandberg, Vice President of Market Access and Reimbursement at Cooler Heads, emphasized the broader mission. "We are dedicated to ensuring that socioeconomic status is never a barrier to care," she stated. "This Medicaid coverage milestone is a vital step toward health equity, and we remain committed to collaborating with payers and providers to expand this access nationwide." The decision in New York marks a pivotal moment in this mission, transforming scalp cooling from a high-cost option to a covered standard of care and reflecting a growing understanding that the journey through cancer requires treating the whole person, not just the disease.