All PlansCoverageMedium impact
Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses
Blue Cross & Blue Shield of Mississippi·MS · Neurosurgery, Plastic Surgery, Pediatrics +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy establishes coverage criteria for adjustable cranial orthoses (helmets) used to treat skull deformities in infants. The devices are covered post-surgery for craniosynostosis and for persistent plagiocephaly in 3-18 month old infants who have failed conservative therapy and meet specific measurement criteria.
Action Required
Immediately: Billing team must establish procedures for cranial orthosis claims requiring documentation of: patient age (3-18 months), failure of 2+ months conservative therapy (repositioning/physical therapy), and cephalic index measurements at least 2 standard deviations from normal for age/gender. Create checklist for providers documenting medical necessity. Claims without proper documentation will be denied.