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Cefaly Insurance Coverage Update

“Is Cefaly covered by insurance?” is the question I’ve been asked most since the device was approved. The answer is probably not, but your insurance company may cover it as they would any TENS unit.

Cefaly does not currently have a procedure code (also called a CPT code), which is required for an insurance company to cover any medical device or procedure. A company representative told me FDA approval is the first step in the long process of getting a CPT code. They expect it to be one to two years before Cefaly has a code.

Hope is not lost! Some migraineurs have found that their insurance companies will cover Cefaly the way they would any TENS unit using an established code for those devices. Google tells me those are E0720 for a two-lead device and E0730 for a four-lead device. The problem? Cefaly only has one lead, which may trip up some insurance companies.

HomeCare, a magazine for the home medical equipment industry, says that to have a TENS unit covered for chronic pain, your doctor must submit a statement of medical necessity and “must determine that the patient is likely to derive significant therapeutic benefit from continuous use of the unit over a long period of time. The physician’s records must document a reevaluation of the patient at the end of the trial period and indicate how often the patient used the TENS unit, the typical duration of use each time and the results.” Unfortunately, the article also says TENS units are rarely considered medically necessary for headache disorders. (This is general industry information. What you encounter with your insurance company may be different.)

Don’t give up without checking with your own insurance company. Enough migraineurs have received positive responses that it’s worth a try. Please let us know if you have success and, if possible, which code your insurance company is using.

Update on Cefaly availability: As of April 9, 2014, the order page of Cefaly’s U.S. website says, “Order intakes on hold for a week because of limitation in the supply chain.” This notice apparently went up today, so 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.

April 15, 2014: Cefaly has removed the “not currently taking orders” notification from their website. They appear to now be shipping previously ordered products and taking new orders.

11 Responses to Cefaly Insurance Coverage Update

  1. I have daily Migraine headaches that I have received maximum available treatments including Cervical Facet and Epidural injections. Most recently my Pain Management physician has completed a series of Cervical Rhizotomies which has offered temporary relief. In addition I have been receiving Botox injections every 3 mo.for the past yr.
    Can the Cefaly possibly be a preventative measure for Migraines of my magnitude?

  2. Kelly says:

    I just ordered a Cefaly unit and my insurance agreed to cover it minus my co-pay for medical devices. It took about 2 months of petitioning from both my doctor and myself but I finally got the green-light to order it. My doctor had not heard of it and neither had the HMO. I ultimately submitted a letter explaining in detail my personal and family migraine history, what I had tried, why I was asking for it and what it was. I included links to the clinical studies and the codes you listed here. I explained that there was no CPT code yet but that these codes were for similar devices. My doctor simultaneously submitted a request twice for medical necessity. I had to buy it and then submit my receipt to claims for reimbursement.

    Thank you for posting the TENS unit codes, I think it helped in making my case to my HMO. Hopefully this helps someone else trying to get it covered by insurance.

  3. Anne says:

    it’s now 3/12/2015………….any news on approval & payment via Medicare?

  4. Chrystyna Alexander says:

    I just learned about the Cefaly device from my pain doctor and have a prescription for it. Does anyone know if there is now a code for this device.
    Also I am a priorityhealth Medicare member, has anyone heard whether they will pay for this device?
    Today is January 8, 2016

  5. cheryl says:

    was denied by KaiserPpermanenty insurance ….neurologist would not prescribe it. a year ago…will try again..also have medical coverage with LA Care. need to try them. Grandma has a medicare advantage with blue cross so will try to go through them

  6. marielis gonzalez says:

    Hi ,I live in Boston ma. I suffer from chronic migraines i was wondering if Masshealth cover for cefaly?

  7. Jennifer DiBlasi says:

    I have a brain tumore in the Trigeminal nerve underwent Gammknife (Radiation Surgery) I suffer from migraines on many levels tried many medsss and while I do research I came upon a Celebrity Bellamy Young that reeps the rewards in a positive way. I brought it up to my Neuro and she agreed gave me the prescription for it. I haven’t sent it into my insurance yet which is UHC Medicare Advantage PPO plan.. Is there a Cpt Code for my diagnosis and need for this device? Please keep me posted as I’m very intrested in purchasing this item.

  8. I am considering this unit. I was diagnosed with a chri malformation and have chronic migraines. Many medications have been tried along with botox😳 But no help!!!! I’m desperate in something to help. I do have BCBS OF TN, ? Covers but I’m willing to try. I’d like feed back for how well it works compared to maybe just a little prior for me paying out of pocket for this since I’m sure my insurance WILL NOT COVER. Angie

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