MedicaidPrior AuthMedium impact
Changes to the Prior Authorization Process for Cranial Remolding Orthoses
Connecticut Medicaid (HUSKY Health)·CT · Pediatrics, Neurosurgery, Plastic Surgery·Prior Authorization
Effective date
Mar 1, 2017
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid is changing the prior authorization criteria for cranial remodeling orthoses effective March 1, 2017, replacing existing medical policy criteria with McKesson's InterQual Criteria. The new criteria specify orthoses are recommended for moderate to severe deformity in children 3-18 months old who have failed at least 2 months of conservative management.
Action Required
By March 1, 2017: Billing team and providers must update prior authorization requests for cranial remodeling orthoses to include documentation of specific measurements (TDD of 10mm+ and Cephalic Index 90%+), patient age 3-18 months, and proof of failed conservative management for at least 2 months. Update clinical documentation templates to capture these required criteria. PA requests without sufficient clinical information will be held pending for up to 20 business days before denial.