HOW TO FILE FOR A MEDICAL CRANIAL PROSTHESIS

This guide outlines the general steps involved in filing for a medical cranial prosthesis (such as a hair system) through insurance. Please note that specific requirements and procedures may vary depending on your insurance provider and individual circumstances.

1. Consult with Your Physician

* Medical Necessity: Your physician needs to determine that a cranial prosthesis is medically necessary for you. This may be due to conditions like alopecia, hair loss from cancer treatment, burns, or other medical conditions.

* Prescribe the Prosthesis: If deemed necessary, your physician will write a prescription for a cranial prosthesis. This prescription should specify the type of prosthesis (e.g., Cranial Prosthesis) and any specific medical requirements.

2. Contact Your Insurance Provider

* Verify Coverage: Contact your insurance company to inquire about coverage for cranial prostheses.

  * Benefits: Determine your coverage limits, any deductibles or co-pays, and if pre-authorization is required.

* Obtain Necessary Forms: Request any necessary forms from your insurance company, such as pre-authorization forms, claim forms, and medical necessity forms.

3. Gather Required Documentation

* Physician's Prescription: Ensure you have a valid prescription from your physician.

* Medical Records: Gather relevant medical records, including any diagnostic tests or treatment records related to your hair loss condition.

4. Submit Your Claim

* Pre-authorization (if required): If pre-authorization is required, submit the necessary forms to your insurance company along with the supporting documentation.

HCPCS CODES FOR CRANIAL PROSTHESIS 

(A9282: WIG, ANY TYPE) 

 (S8095: CRANIAL PROSTHESIS)

* File Your Claim: Once pre-authorization is approved (if applicable), submit your claim to your insurance company.

  * Include: Include the prescription, invoices from the prosthesis provider, and any other required documentation.

5. Track Your Claim

* Contact your insurance company: Follow up on the status of your claim within the timeframe specified by your insurance policy.