Cranial Orthotics 1.01.32
Excellus BlueCross BlueShield cranial orthotics medical policy 1.01.32 has a current effective date of October 22, 2026, and its annual review kept the policy intent unchanged. A cranial orthotic, such as a helmet or cranial remolding band, is considered medically appropriate for moderate to severe non-synostotic positional plagiocephaly in children aged 3 to 18 months after a failed two-month trial of conservative treatment, when cranial vault asymmetry is greater than 12 mm or the cranial vault asymmetry index is 6.25% or greater, or for brachycephaly when the cranial index is less than 76% or greater than 90%. It is also considered medically appropriate for craniosynostosis after surgical correction. Cranial orthotics are contraindicated for hydrocephalus and for craniosynostosis without prior surgical intervention, and they are considered not medically necessary when used for aesthetic mild non-synostotic plagiocephaly, as the sole treatment of synostotic plagiocephaly, or as replacement orthotics.