shaping symmetry one child at a time
Cranial Kids offers FREE consultations! We will determine if your child’s head measurements are out of the normal range and how much.
As you might expect, it is difficult to make any definitive statements about insurance coverage, because so much depends on individual policies, coverage and companies. To be sure of your coverage, always contact your insurance company before your first visit with an orthotist! Ask if your policy covers Durable Medical Equipment (DME) and further, if they cover billing code S1040. They may say they cover L0100, but that is for a protective helmet, not a cranial remolding orthosis. Cranial remolding orthoses fall under orthotics and prosthetics, which typically is a sub-section under “Durable Medical Equipment” (DME) under most insurance plans. Some insurance carriers will pay for the orthosis if measurements indicate that the baby’s head has a moderate-to-severe deformity and your physician writes a letter stating that a custom cranial orthosis is medically necessary. This letter may also specify whether the deformity was present at birth and highlight potential problems that might occur if the problem is not treated at this time.
In order for Cranial Kids to receive authorization through your insurance we will need a prescription from your doctor and possibly proof that repositioning or physical therapy during a prescribed time period was unsuccessful. We will work with the medical team to ensure all documentation is received.
If insurance doesn’t cover cranial remolding orthoses, parents should discuss payment plans with Cranial Kids.