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Cefaly Availble in the US, Insurance Coverage

If you’re in the US, you can now order a Cefaly from Cefaly.us. The device itself is $295 (plus $29 for shipping) and a three-pack of electrodes is $25. You must send a copy of your prescription before they will send your order. Devices will be delivered beginning the first week of April.

Here’s what Cefaly’s FAQs currently say about insurance coverage:

Cefaly is not currently reimbursable via the social security system and therefore is not listed in the catalogue of approved medical devices. However it is becoming increasingly apparent that certain health insurance companies and mutual funds are partially funding this treatment and may do so on a case-by-case basis.

We therefore advise that you write to your insurer or health care in order to ask them if they will help you with the cost of Cefaly. Explain your migraine problem and the benefits that the device brings you. Make sure you to attach a prescription along with a copy of the invoice to your letter.

Translated: Your insurance company might reimburse you, but probably not. Sending your insurance company a letter with your receipt, as the Cefaly website recommends, is unlikely to work out in your favor. If insurance coverage is imperative for you, contact your insurance company before purchasing the device. They may refuse to cover it at all or they may allow you to submit an appeal for coverage. Be sure to ask if having your doctor send a letter of medical necessity will increase the chance that they’ll cover it.

April 8, 2014: Check Cefaly Insurance Coverage Update for current information.

45 Responses to Cefaly Availble in the US, Insurance Coverage

  1. Timothy Bauer says:

    To everyone:

    Some further info. If order-company requests you send prescription
    order from doctor-thru email-pdf file. In Reno here-Cefaly indicated
    would take 3 weeks to arrive.
    Will cost a person around $349 total-device shipping, electrodes. Hope this helps.

  2. Melody Stiles says:

    I talked to Anthem yesterday and they said they would be willing to pay for it the same way they do any another “sustainable medical device, like a TENS unit” but they could not locate a “code” for the device. I have, literally, called all over the world trying to find out the “code” and have not had any luck yet. But I think this is very encouraging. I have not given up my search yet.

  3. Loretta says:

    I also have Anthem and was told it would be covered but I need the procedure code or the PTC Code. I have ordered mine already because as anyone with migraines knows we will try most things to help us, even at the cost of 349.00. If someone does know the code please post it for us. I will if I can find this code. Best of luck to us all.

  4. Loretta says:

    Cefaly answered my question about a Procedure Code here is there reply.
    Unfortunately there is no CPT code and it is not covered by insurance. Actually FDA approved Cefaly recently. This is a first step before a submission to get a code for insurance coverage. The process is long and therefore we cannot expect Cefaly to be covered by insurance before one or two years.

  5. Frieda says:

    Here are some codes
    T.E.N.S. HCPCS codes, modifiers, and supplies

    A4595: Electrical stimulator supplies, two leads, per month.

    A4630: Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient

    E0720: Transcutaneous electrical nerve stimulation (T.E.N.S.) device, two lead, localized stimulation

    E0730: Transcutaneous electrical nerve stimulation (T.E.N.S.) device, four or more leads, for multiple nerve stimulation

  6. Frieda says:

    The codes I posted are for T.E.N.S. home units and I don’t see why they couldn’t be used for the Cefaly unit. The insurance companies probably are not that anxious to pay for it…..

    • Thanks for sharing. I can see some companies not covering Cefaly because it has only one lead and the codes are for two or four lead devices, but it sounds like some people are getting it covered.

  7. Brett says:

    Ceflay site’s order page says “We are currently not taking orders for the US ” (4/9/14).
    Anyone know how to order in US, I have an Rx from Dr.

    • Unfortunately, it’s the only way to order in the U.S. unless you can find a non-U.S. supplier who will ship to you. The site now says “Order intakes on hold for a week because of limitation in the supply chain.” I hope that means you’ll be able to order from them next week. I’ll keep an eye on the site and let you know if anything changes.

  8. Loretta says:

    I just got my Cefaly Migraine device today, I read the manual then used it. I really didn’t know what to expect but it is very intense. I am desperate to get rid of my migraines so I let the device go to the maximum level for a 20 minute session. It feels like lots of bee stings, not really painful but uncomfortable. The manual says you will get used to it. It say’s it can make you sleepy after the treatment, and that did happen to me. It took me about 1 to 2 hours to fell like myself again. I would describe it as kind of a foggy state and you just want to rest. I hope it works, after it arrives in the US they hold it about 1 week so FDA and others make sure the device is what it say’s it is, and you had a prescription for it.

  9. Mary Sedlak says:

    I need help as I have been trying to find a way to order Cefaly for my husband who has suffered with migraines for most of his life. They have, within the last 5 years, caused him to become quite debilitated, as he spends most of his time in bed where he gets the most relief. He is also on several pain medications. Where can I order Cefaly for him? He has a prescription from his neurologist. I’m not very computer savvy and would instruction on how to provide the prescription.

    Mary

  10. Loretta says:

    Mary I know how bad migraines can be I will do my best to explain how I got mine. The web site is http://www.cefaly.us. You go to that site click on buy and you will see the device, click buy and you will be taken to a page where you fill out your mailing info and they will ask you for a prescription. You can scan your prescription into your computer if you have a scanner and send it to http://www.info@cefaly.us. You can also fax it to 011 324 3676702, if you have a Office supply store or some type of copy store they can fax it for you, just make sure you have his info on it. Then you will be asked to pay for it after you fill out that page , they will get your prescription and then mail it to you. It took me about 2 weeks for the whole process. When it gets to the US customs will hold it to make sure it is what the package says and check your prescription. That can hold it up a week, but believe me it is well worth it. There will be a shipping cost of 29.00 also. Good Luck!

  11. Susan Carpenter says:

    Medicare told me they will cover it and then my medigap insurance said they would cover the rest if medicare covers it. how do i go about ordering the unit with Medicare?

  12. Stephanie says:

    can any one tell me how much medicare pays

  13. Stephanie says:

    can some one tell me how much Medicare pays towards this?

    • Stephanie, my guess is that they don’t and won’t until Cephaly has the necessary codes, but I could be wrong. Your best bet would be to call Medicare directly.

      Take care,
      Kerrie

  14. Anita says:

    I ordered the Cefaly a little over a week ago and sent in a scanned prescription. I have e-mailed the company twice to find out when it will be shipped, but I don’t get an answer. Does anyone have a phone number I can call from the US?

  15. Howie says:

    I find this very interesting in that my 9 yo daughter was just prescribed the Cefaly by the pediatric headache specialist at a major medical school. It is available through Costco in the US. http://reviews.costco.ca/2070-en_ca/10353011/stx-med-cefaly-anti-migraine-device-reviews/reviews.htm
    A standard TENS unit can be adjusted so that the stimulation is not uncomfortable. I don’t know if there is some special frequency of stimulation that the Cefaly employs that is not avaiable on the TENS. Note that in the past the TENS reps have said that the TENS can be used anywhere below the ears.
    Another consideration would be a Pulsed Electro Magnetic Field unit. They are FDA approved for the arthritis pain in the knee as made by Orthocor, but are used for many things in Europe.

  16. Howie says:

    Sorry, that’s Costco in Canada.

  17. kathy says:

    I have been using this now for a couple of weeks. Not real clear how often to use use it. It automatically shuts off so you do not have to monitor how long you have it on.
    This may seem like an odd question but does it matter if you have your eyes open or shut as the sensation is quite different if eyes are open or shut? It seems to be helping but I will hold out to see if it continues to help over time.

    • Kathy, I don’t think it matters if you have your eyes open or closed, but your doctor might be able to tell you. I’ve only heard of it prescribed for use once a day as a preventive, but your doctor may have other instructions. I hope you continue to find relief with it.

      Take care,
      Kerrie

  18. valerie gregory says:

    I am having trouble ordering the cefaky

  19. Lydia says:

    My Neurologist wrote me a prescription for it and no company here can order it because there are no suppliers here. She told me if there is a way to get it, to wear it for 20 min. per day, everyday. I have been having severe migraines for many years, since childhood. She give me shots to my head/neck every 3 months. I have Medicare and Medical. I live in California. I haven’t heard back from the company yet on how I could get it and if the insurance would cover. My Neurologist did mention that a few of her patients was able to get it by their insurance company (Blue Cross, etc.), but has not seen anyone who is on Medicare/Medical get it covered. Being on limited income, this is hard. I have a prescription for it, but am told to do more research on how to get it for me and other patients. Anyone have ideas? I notice that Canada will not ship to the US. I have contacted the US company, but haven’t heard back yet. All I see is that Canada sells there’s at Costco for $299.99 and the USA & Cefaly Company sells for $349 plus $25 for the electrodes. Anyone else find something less expensive? Thanks a bunch for assisting in our request. 🙂

  20. Nancy Palmstrom says:

    Related to Anthem coverage of Cefaly. I found a summary on the Anthem site related to medical necessity of Cefaly for migraines, and its conclusion is it is investigational and not medically necessary. https://www.anthem.com/medicalpolicies/policies/mp_pw_a049569.htm

    It’s possible they may have changed their stance since publishing this medical policy. I’ve not yet contacted them to request authorization, but this doesn’t give me great hope for approval. That said, I’m still going to give a shot at getting insurance to cover.

  21. Medea Bendel says:

    I had a severe migraine instigated stroke in 2002 and have been having issues lately that may indicate I am having smaller but similar episodes and I have a migraine more days than I don’t have one. Anyone with a similar history trying the device? If so, how is it working for you. I am desperate here for something that can help.

  22. Lydia says:

    Medea – I broke down and bought the device since my migraines take over my life at times. Insurance did not cover, so I am in the process of appealing it again (and still paying for the bill with Credit Card interest). When I use the device, I honestly say that it is not 100% effective to get rid of my migraine, but it sure help relieve it mostly. Basically, the migraine turns into a headache or at least one that I can handle much better. To be fully effective, it is an everyday use item according to my doctor who prescribed it for me. I miss days and I can tell the difference. After I wear the device, the front half of my head feels literally numb. This device has two settings that I know of and use the stronger setting because I like the feeling and it seems to help me better. Since my Case Manager is helping me with trying to get Medicare/Medical to refund me, he wanted to test it. He didn’t like it, it hurt and made him sleepy. I turned down the setting for him and he was still bothered by the unit, he didn’t like the “tiny needles” feeling. I personally would recommend it just to deal with migraines that are taking over one’s life. Hope this helps.

  23. Chrys says:

    PRICE UPDATE. I just spoke with the rep at cephaly.com. US not Canada. Currently the price is $349 just for the unit, $15 for shipping and $25 for a package of 3 electrodes. You have to buy the electrode package because the unit comes with only one electrode which lasts 20 days. Since it takes at least 4 weeks of daily use to get the best benefit, the one electrode that comes with the unit would not work that long.

    If this device works, all is great but if it does not, you have 60 days from date of receipt of the device to return it. They will only refund the $349 for the device. No refund for shipping, you cannot return the electrodes and you have to pay for the return shipping.
    This means that if it works, life will be great and the device worth every penny but if it does not help you, you will be out $15 for the shipping, $25 for the electrodes and about $10 for return shipping (total= $50).

  24. B W says:

    My son (17 yrs old) has suffered for a few years from migraines, and having tried many medications his neurologist prescribed the Cefaly device.
    I called the insurance company (United Healthcare) with the prescription and they sent it out for review.
    Today they told me that they denied the claim because the medical director “could not find sufficient evidence from peer-reviewed journals” to support the efficacy of the device to help my son.
    I stated that I have seen journal articles and also it was FDA approved but they said FDA approval was not enough to merit the claim. They said I can appeal if I have knowledge of peer-reviewed articles.
    Does anyone have any advice for me ? or have a list of peer-reviewed articles in journals that I could use in my appeal?

  25. Lydia says:

    B.W. – I would recommend you to contact your son’s neurologist and get any information from their office since the doctor is the one who prescribed it. I personally have not read any articles regarding the device, but it does help. I have had mine for six months or so and it helps lesson the migraine, not cure them. After I may have a slight headache that I can tolerate, better if I napped after using the device. Sometimes I just have to drink extra water and use the device and noticed that helps me more for some reason. Also, I would call the company and see if they are willing to send you any information that you can pass onto your insurance company. Since I have been using the device, I am taking less Imitrex-Nasal, Phenergen, and Steroid shots to the back of my head. Less chemicals put into the body which is always a good thing! Hope this helps. 🙂

  26. Olivia says:

    B.W., here is a list of peer-reviewed articles : http://www.cefaly.us/en/clinical-studies 🙂

  27. Norm says:

    I am wondering if anyone has used this for trigeminal neuralgia ?

  28. Heleln Walker says:

    I awaken one night while lying on the carpet with the worse headache I had ever experience without warnings in 2014 . Today, 3/2017 I am still having headaches. Been told I have migraines, icepick headaches????????. Don’t know but have been on more medication than I care to name but no positive results. Wondering if CEFALY really work. Cant worry whether or not my insurance will pay. More interested if it will help my headache. Headaches mostly at night on one side on head (left). Rating-10+. Cry like heck.

  29. Lydia says:

    The Cefaly device does help my migraines, a lot of times, but not 100%. I also do Botox shots now and find that I have more relief from doing both. I went from having migraines every week to every 6-8 weeks. Amazing relief.

  30. Rebecca says:

    Costco in the US sales the device. Has anyone had any luck with Aetna covering Cefaly?

  31. Jude says:

    How did you find Cefaly at Costco? I do not find it in a search.

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