Insurance Reimbursement for Wigs

Wig Reimbursed By Your Insurance Company & ICD-9 CPT Codes For A Cranial Prosthesis

If you or someone you love needs to wear a wig because of medical reasons the “wig” should be called a “cranial hair prosthesis” for insurance purposes. If a person requires a cranial prosthesis due to Medical related hair loss they may be eligible for reimbursement under their health insurance. Most insurance companies will cover from 80% to 100% of a cranial prosthesis.

  1. Most insurance policies cover “Prescribed Cranial Prosthesis” though does not cover wigs.
  2. The Insurance C.P.T code most commonly used is CPT-ORN-1.
  3. Get a letter and/or prescription from your doctor.
  4. Make sure that the letter or prescription is for “Prescribed Cranial Prosthesis”
  5. It should not say wig-if it does, have it redone, otherwise your claim will most likely be refused.
  6. Have a receipt from the person performing the service (from whom you purchase the Cranial Prosthesis). Make sure it says “Prescribed Cranial Prosthesis.”
  7. Have the person who performed the service signoff on your claim, i.e. the “Dr.s” portion of your claim form. Waiting for your claim to be processed – prepare yourself for having claim denied.
  1. Know your rights as the insured party.
  2. Obtain a copy of your FULL contract with your carrier (most of us only have a “Summary of Benefits” provided by the employer).
  3. Read and know your contract.
  1. Pay attention to the “exclusions” Wigs are excluded for cosmetics reasons.
  2. Pay special attention to Prosthesis coverage. Most policies do not spell out exclusions under Prosthesis, and this is how you are likely to have your claim accepted. Submitting your appeal – (after denial of claim as not a covered benefit)
  1. Write asking for a review by the Medical Review Board.
  2. Attach copy of original claims.
  3. In your letter, inform them of the difference between a wig and Prosthesis. (A wig is a fashion item and not a necessity. Prosthesis is a necessity comparable to plastic surgery for a burn victim).
  4. Ask for a written reply. (Companies try to avoid putting anything in writing).
  5. Address your letter to a supervisor in the Claim Department.Please contact us at 949 646-9447 if you need any assistance with filing your claim.

Sometimes doctors do this when the codes are not necessary and it is also used to save money for the patient or the insurance company.

No medical bill will exclude an ICD-9 that is necessary. If the procedure was performed, the ICD-9 code will be included.

Our consultation is designed to discuss your options. Together we will come to a solution that fits your need and lifestyle.