Medicare Coverage & Reimbursement for HIFU
Medicare began covering the facility portion of a HIFU procedure in July 2017. Unfortunately, as of January 1, 2019, the reimbursement for HIFU was slashed to the point where no facility could afford to provide HIFU procedures.
The Centers for Medicare and Medicare Services (CMS) substantially lowered the facility reimbursement rate so that hospitals’ outpatient surgical centers and Ambulatory Surgery Centers can’t afford to offer HIFU in their facilities. In fact, the reimbursement rate is so low that it does not cover the costs of the supplies needed to perform the procedure.
Please be advised, if you are a patient with Medicare you can still elect to have your HIFU procedure at Western States HIFU, but you will be responsible for 100% of the cost of the procedure. We are sensitive to the financial cost and offer an all-inclusive price for the HIFU procedure, including surgery center facility fees, HIFU physician charge, anesthesiologist fee, and your pre and post HIFU care. We also work with HIFU Prostate Services to assist you with financing options.
Other HIFU Related Expenses
Your initial prostate cancer office visit (consultation) with Dr. Robert Pugach may be covered by Medicare. We are happy to check your Medicare benefits without charge. Just call 877.884.4438, so we can verify if your Medicare Plan will cover our consultation.
The cost of pre-HIFU medical clearance and any lab tests required by your anesthesiologist are not included in HIFU fees. We will outline all of this for you in detail so there are no unforeseen financial surprises. The cost of this testing is usually very nominal.
Additional Medical and Laboratory Information
We’re here to help you. Providing your clinical information to us facilitates that! While every patient’s medical information varies, there are certain items that help us determine if HIFU may be an appropriate treatment option for you. The most important medical information and laboratory tests you can provide are:
- Pathology report from your biopsy
- PSA results – actual lab slips going back as far as you can find them
- Copies of the ultrasound images that were made when you had your biopsy
- MRI report, if you’ve had one done
- Bone scan results, if you’ve had one done
- Results of any genetic testing from your biopsy
- Copies of office records from your urologist
- Copies of reports from any consultants you’ve seen
*At Western States HIFU, we work closely with HIFU Prostate Services, LLC (the country’s most experienced HIFU provider), to streamline the entire process including payment processing. HPS has reimbursement specialists standing by to assist you without charge. Please call us to discuss financial arrangements and financing options.
If you are in the greater Los Angeles and Orange County area, or surrounding communities, we offer convenient appointments at our office in Los Alamitos. We typically schedule appointments at the end of each day so you won’t feel rushed as we discuss your prostate cancer and treatment options.
**For patients who live in more distant areas of California, neighboring states, other parts of the U.S., or if you are an international patient, Dr. Robert Pugach offers online/virtual or telephone consultations in a time zone that is mutually convenient.**