Depending on your coverage, you may be eligible to have some or all of your wig reimbursed by your insurance provider. A custom wig is considered a cranial prosthesis which falls under the durable medical equipment category.
A cranial prosthesis is different from a traditional wig in regards to quality, performance, and service. These prostheses are intended for people with severe hair loss and consist of specialized materials. Contact your provider to find out what your coverage is concerning durable medical equipment and the process you must take to file a reimbursement claim for the cost of your wig.
We are not currently listed as providers so we cannot bill your insurance company directly. In order for construction to begin on any new custom wig order, payment is required up front. After payment is completed, we will give you a sales receipt that you can then submit to your insurance company so you can get reimbursed for your purchase. We can list any address or CPT Code you would like us to on your sales receipt. If there are no providers in-network, some insurance companies allow you to use your out-of-network benefits as in-network benefits. Contact your provider and ask them if this is an option under your plan.
We also recommend getting a prescription from your doctor to boost your reimbursement claim. Explain to your doctor that you need the prescription to be written for a cranial prosthesis and not a wig for insurance purposes. If they know the CPT Code your insurance company requires, ask them to include it on your prescription. Acquiring a prescription is for insurance purposes only and is not required to get a wig from Compassionate Creations. If you are denied coverage, you can always appeal. We suggest enclosing a letter to your insurance company stating the emotional side effects of your hair loss and how it has impacted your daily life
The most commonly used CPT codes for reimbursement/billing of a cranial prosthesis are:
- A9282 “Wig, Any Type, each”
- D5924 “Cranial Prosthesis”
- S8095 “Cranial Prosthesis”