Summary: Thyroid radiofrequency ablation (RFA) is a minimally invasive alternative to surgery for treating thyroid nodules. Insurance coverage is evolving, with new CPT codes improving reimbursement potential. Understanding coverage criteria, costs, and reimbursement processes is essential for clinicians and patients.
- Insurance Coverage: RFA is covered in many cases, but approval depends on demonstrating medical necessity.
- New CPT Codes: Effective January 1, 2025, CPT codes 60660 and 60661 streamline the billing process.
- Benefits of CPT Codes: Standardization, improved reimbursement, expanded insurance coverage, and increased legitimacy of the procedure.
- Cost with & without Insurance: Out-of-pocket costs range from $5,000–$10,000, but RFA is often more cost-effective than traditional surgery.
- Clinician Support: STARmed America provides reimbursement assistance to help clinicians navigate insurance approvals.
Radiofrequency ablation (RFA) is emerging as a minimally invasive alternative to thyroid surgery. This effective treatment for benign thyroid nodules and select malignant indications is vastly more cost-effective for clinicians.
Each day, more clinicians consider adding thyroid RFA to their practice to expand access to this life-changing procedure. Before the transition, one of the most pressing questions is: Is RFA covered by insurance?
Insurance coverage for thyroid RFA is evolving. However, with a new dedicated CPT code available, this is the perfect time to adopt this treatment. Understanding the latest CPT codes, reimbursement trends, and out-of-pocket costs can help both clinicians and patients navigate the financial aspects of this treatment effectively.
Continue reading to learn more about how much radiofrequency ablation costs with insurance. Plus. explore the potential cost without insurance, and how to determine if RFA is covered by insurance for your patients.
Does Insurance Cover Thyroid RFA?
The short answer is that insurance coverage for Thyroid RFA is continuously evolving. That means that there is great variability between providers and plans. However, radiofrequency ablation is covered by insurance providers in many cases.
Regardless of your patient’s insurance plan, coverage decisions often hinge on demonstrating medical necessity. Thus, the onus is on clinicians to provide evidence of symptoms. Mild cosmetic symptoms alone may not be sufficient. Often, any cosmetic complaint must be accompanied by a significant symptom or complication.
According to Cigna Healthcare, the most commonly accepted indications include:
- Compressive or functional symptoms. Dysphagia, dyspnea, persistent hoarseness or voice changes, neck pain or discomfort.
- Cosmetic concerns due to nodule enlargement. Cosmetically disfiguring thyroid nodules, nodules that cause noticeable neck swelling or asymmetry.
- Nodule growth or recurrence after prior treatment. Typically, an increase in size of 20% or more over a defined period and/or proof that RFA is a less invasive, safer alternative for recurrent nodules.
- Hyperfunctioning thyroid nodules. Nodules that cause hyperthyroidism may qualify if RAI therapy is contraindicated or ineffective, medications are poorly tolerated, TSH, T3, and/or T4 confirms hyperthyroidism, and thyroid uptake scans show increased nodule activity.
Since insurance policies vary, preauthorization is often required. You’ll need to submit a preauthorization request with comprehensive medical documentation of the above symptoms. Aim to use clear language to align with insurer policies, which is crucial for success in the age of AI.
New CPT Codes for Thyroid RFA
Historically, RFA was processed under “unlisted endocrine procedure” codes, leading to inconsistent coverage. However, the introduction of two specific CPT codes, effective January 1, 2025, is anticipated to improve reimbursement processes.
Those codes are:
- CPT Code 60660: This code is designated for the ablation of one or more thyroid nodules in a single lobe or the isthmus, performed percutaneously and includes imaging guidance.
- CPT Code 60661: An add-on code used in conjunction with 60660. It applies when additional nodules in another lobe are ablated during the same session, also including imaging guidance.
The establishment of CPT codes 60660 and 60661 is a positive development, but coverage is not yet universal. Currently, HAP, Cigna, Aetna, Medicare, Medicaid and selected Blue Cross Blue Shield policies cover the cost of this treatment. Clinicians still must work closely with patients and insurance providers to navigate the approval process effectively.
However, the existence of these codes is a net positive for the reputation of this efficacious and cost-effective procedure. It signifies the recognition of thyroid RFA as a standard medical procedure. Additionally, it signals several key points regarding the efficacy, legitimacy, and acceptance of the treatment within the medical community and among insurance providers
Benefits of an Established Thyroid RFA CPT Code
As more insurers align with these coding changes, thyroid RFA is expected to become a widely covered, first-line treatment option for eligible thyroid nodule cases. Here are some of the benefits of CPT code adoption.
- Recognition by the American Medical Association (AMA). Before assigning a CPT code, the AMA reviews clinical evidence, safety data, and efficacy studies to determine whether the procedure is medically viable and widely accepted.
- Standardization of the procedure. This standardization improves reimbursement consistency, making it easier for providers to obtain insurance approval and reduce claim denials.
- Clinical validation and research support. The introduction of a new CPT code suggests that published research and clinical trials have demonstrated that RFA is a safe and effective alternative to thyroid surgery for eligible patients. This supports its inclusion in standard clinical guidelines and hospital protocols.
- Expansion of insurance coverage. Many insurance providers base their coverage decisions on CPT codes. That means more patients will have access to RFA as coverage policies evolve.
- Increased provider and patient confidence. The presence of a specific CPT code legitimizes thyroid RFA as a mainstream, evidence-based treatment.
Radiofrequency Ablation Cost with and Without Insurance
What if a patient’s insurance does not cover ablation? The cost of thyroid radiofrequency ablation varies based on several factors, including:
- Insurance coverage
- Geographical location
- Provider expertise
- Procedural complexity
For patients without insurance, the out-of-pocket expenses for thyroid RFA can be significant. According to Dr. Emad Kandil, the average cost in the US ranges from $5,000 to $10,000. Some specialized centers may charge more. However, you may find lower prices at international clinics.
When comparing RFA to traditional thyroidectomy, studies have shown that RFA can be a more cost-effective option. For instance, the total cost of RFA is approximately $8,726. That is significantly lower than the $19,229 associated with traditional thyroid lobectomy.
Patients with limited coverage might consider payment plans, medical loans, or pursuing discounts for upfront payments.
How Clinicians Can Help Patients Navigate RFA Insurance Today
STARmed America is the only company offering reimbursement support to our cooperating clinicians. Learn more about Thyroid RFA and how STARmed can help you implement it into your practice.
