What is a Medical Grade Wig/Cranial Prosthesis?

A cranial hair prosthesis is a custom hair system custom designed for individuals suffering from health-related hair loss. It’s important to know the terminology such as alopecia, chemotherapy, autoimmune disorders, trichotillomania, or other medical condition when applying for medical insurance or tax deduction status. Other common terms used to describe a medical wig include cranial prosthesis, medical grade wig, hair prosthesis, and full cranial prosthesis.

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How does this process work? 

Whether or not your medical wig is covered by your insurance company depends on your plan. But it’s possible to receive full payment for your full cranial prosthesis. Once you can file an insurance claim you will know if insurance covers full or partial cost of your cranial prosthesis. Insurance companies have the option to pay for wigs or reimburse clients for wig purchased. 

Insurance companies currently allow one cranial prosthesis per year for medical hair loss. 

Furthermore, you may also be able to deduct your medical grade wig as a medical expense on your yearly taxes if medical bills exceed 7.5% of an individual’s income, qualifying wig as a tax deductible. Discuss this process further with this with your tax preparer or financial advisor.

 

The Steps:

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01   Call and find out if this is covered through your health insurance. Whether or not your medical wig is covered by your insurance company ultimately depends on your health plan. Generally, Individuals suffering from health-related hair loss whether temporary or permanent can be prescribed a medical grade wig. This includes hair loss related to alopecia, chemotherapy, autoimmune disorders, trichotillomania, or other medical conditions, is often covered by healthcare insurances.

 

Important questions to ask insurance representative:

• Does your policy cover a cranial prosthesis (medical grade wigs)?

• If so, what type of cranial prosthesis is covered (I.e. human hair wigs, synthetic wigs, etc.)

• How much of the cost do they cover?

• Do you pay upfront or offer reimbursement?

• What specific terminology for a medical grade wig should be written on the prescription?

• Is there required documentation they need to submit your claim? What is it?

Note: In reviewing your insurance policy and you don’t see cranial prosthesis listed, don’t assume don’t have coverage. Instead, we recommend that you call your health insurance company and a get pre-authorization.

 

02  Make an appointment with your healthcare provider and make the focus or chief complaint of the appointment “hair loss”. Discuss your health-related hair issues with your provider. Then ask for a “cranial prosthesis” prescription from your doctor. Please include the correct terminology required by your health insurance provider as well. Tell your healthcare provider to include procedure code/CPT code: A9282, D5924 OR S8095. It’s important that the prescription does not say “wig”. Because a wig is considered a cosmetic product, and insurances will deem it not medically necessary. This procedure code/number on your cranial prosthesis prescription is what we use to submit your insurance claim.

 

03  In addition, have your healthcare provider write a letter of recommendation on behalf of your hair loss journey primarily emphasizing that your cranial prosthesis is not for cosmetic reasons, but for your psychological health.

 

04   Be sure you keep copies of all your invoices and documentation from your medical provider for tax exemption or reimbursement purposes. Discuss this process further with this with your tax preparer or financial advisor. 

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• If you are purchasing your unit out-of-pocket after making payment email mzlwigtherapy@gmail.com with your order number. Let us know that you need a copy of your invoice for your cranial prosthesis prescription.

 

• We will provide you with your invoice containing a notation that states Cranial Prosthesis and our tax ID number.

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• Send all documentation to your health insurance provider. This includes your doctor’s prescription, completed insurance claim form, invoice from Mizellore Medical Solutions LLC., and any other necessary forms.

 

Options If Insurance Doesn’t Cover Your Medical Grade Wig:

 

One: Can appeal the denial and review the process make needed correction then reapply.

 

Two: If you decide to self-pay for your wig, save your receipt and documentations for possible tax-deductible opportunities. Please discuss this process further with this with your tax preparer or financial advisor.

 

Three: Speak to your social worker or doctor about local resources! Call your local division of the National Alopecia Areata Foundation, the American Cancer Society, and other foundations. Depending on their requirements, you may be able to quality for financial assistance toward a medical grade wig.