CommercialCoverageMedium impact
Cranial Orthotics 1.01.32
Excellus BlueCross BlueShield·Pediatrics, Neurosurgery, Plastic Surgery·Children's Health (Pediatrics)
Effective date
Feb 16, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their cranial orthotics policy effective February 16, 2026, establishing specific criteria for coverage including age restrictions (3-18 months), failed 2-month conservative treatment, and documented cranial asymmetry measurements. The policy clarifies contraindications and situations where cranial orthotics are not medically necessary.
Action Required
By February 16, 2026: Billing team must update prior authorization requirements for cranial orthotics claims to include: 1) Patient age verification (3-18 months), 2) Documentation of failed 2-month conservative treatment trial, 3) Cranial asymmetry measurements (CVA >12mm or CVAI ≥6.25% for plagiocephaly, or cranial index <76% or >90% for brachycephaly). Update encounter forms to remind providers of documentation requirements. Claims without proper documentation will be denied.