What is a Cranial Prosthesis?

The term cranial prosthesis (“hair prosthesis”, or “medical wig”) is used to describe a custom-made wig that is designed for patients who have lost their hair due to medical conditions such as Alopecia Areata, Alopecia Totalis, Trichotillomania and Chemotherapy.

Cranial hair prostheses are different from regular wigs.  The procedure of making a cranial hair prosthesis involves several steps, including measuring the perimeter of the head mold to ensure a perfect fit.  Molds are also made at the base of the head to ensure the wig fits properly.  People who suffer from chemotherapy tend to be sensitive to materials and their scalp is susceptible to allergies, so the base is made of hypoallergenic lace or fabric foundation.

Additionally, the base of human hair is ventilated so that the knotting does not touch the scalp.  You may use the silk top ventilation method or simply coat the underside with wig poly to accomplish this.

Benefits of a Prosthesis

  • Non-Allergenic/No irritation
  • Breathable/Ventilated
  • Covered by many insurance companies
  • Natural-looking hairline
  • No Slippage
  • Comfortable around the ears
  • Lasts up to 2+ years with proper maintenance
  • The unit is made with human hair!  Treat it as your own.  It can be dyed, shampooed, conditioned, straightened, and curled.

Did you know that there are multiple wig cap variations and foundation combinations that can be used to create your cranial prosthesis?

You should know that insurance companies set their own policies when it comes to accepting insurance payments for medical wigs. Moreover, different plans under the same insurance company will have different limits and exclusions, so it is very important that you understand that the process may vary from claim to claim. As a result, most of the time, the process will follow a pretty standard pattern. You just need to know what information to ask for, what forms to look for, and who to contact if you need help.

Here are the preliminary steps to follow before filing a claim:

Step #1 – Obtain Insurance Verification

Step #2 – Secure a Prescription

Step #3 – Schedule a Consultation

Step #4 – Place an Order

Filing a Claim

Filing a claim for a medical wig or cranial prosthesis can be challenging if you are not experienced with the process. It is critical that you obtain the relevant information from your client and submit the claim with the proper wording and codes. In addition to these items, your client should also include a letter describing how hair loss has affected them. Include any emotional impact on daily life and things that have happened because of the condition.

Types of Hairloss Covered by Health Insurance Companies (Caused by the Following Conditions)

  • Alopecia
  • Trichotillomania
  • Chemotherapy Treatments
  • Thyroid Problems
  • Radiation Treatments
  • Kidney Diseases
  • Cancer

Several health insurance companies offer 80%-100% reimbursement for human hair wigs and hair toppers (insurance companies refer to them as “cranial prosthesis”). Human hair wigs and hair toppers are essential in restoring your client’s appearance and confidence. This is an invaluable service to provide to someone suffering hair loss due to Cancer and various forms of Alopecia. 

If you’d like to learn more, please enroll in our full course How to Bill for a Cranial Prosthesis.

What you will learn:

  • Understand the purpose of a Cranial Prosthesis, its benefits, and the foundation materials that support this type of unit
  • You will be able to navigate through the application process and how to obtain your NPI number
  • Determine what information should be discussed during the client intake process
  • Discover the steps to file a claim and an appeal
  • Acquire information on how to submit claims to the Department of Veterans Affairs (VA)
  • How to apply for a grant or voucher
  • Identify the largest medical providers by state and which locations are searching for a Cranial Prosthesis Specialist