Please note: Coverage varies by individual plan and changes year to year. Always verify your specific benefits by calling the member services number on your insurance card before purchasing. The House of Postiche provides documentation to support your claim but cannot guarantee coverage outcomes. This guide reflects general industry knowledge and is for informational purposes only.
The Most Important Thing
Never Say "Wig" —
Always Say "Cranial Prosthesis"
This single distinction is the difference between coverage and denial for most patients. Insurance companies that deny "wigs" routinely approve "cranial prosthetics" — because they are classified differently in medical billing.
Key Language
Always use: "Cranial Prosthesis"
When speaking to your insurer, when asking your doctor for a prescription, and when submitting your claim — always use the term "cranial prosthesis." This is the medically recognized term and the one that triggers coverage under most benefit plans. The billing code is HCPCS A9282.
Insurance Providers
Coverage by Insurance Company
Coverage varies significantly between carriers and even between plans within the same carrier. Here is a general overview of what to expect — always verify with your specific plan.
Aetna covers cranial prostheses for hair loss resulting from chemotherapy, radiation therapy, or alopecia areata in many of its plans. A physician's prescription and Letter of Medical Necessity are required. Some plans cap coverage at $350–$500 per calendar year.
Tip: Ask Aetna specifically about "cranial prosthesis benefit" and request the CPT/HCPCS code A9282 be checked against your plan.
BCBS coverage varies significantly by state and plan type. Many BCBS plans cover cranial prosthetics when medically necessary due to cancer treatment or diagnosed alopecia. Some plans include it under durable medical equipment (DME) benefits. Annual limits commonly range from $350 to $1,000.
Tip: Contact your local BCBS chapter directly. Plans in some states are more generous than others.
Cigna covers medically necessary cranial prosthetics for patients experiencing hair loss due to chemotherapy, radiation, or diagnosed alopecia areata. Coverage is typically subject to your plan's DME benefit. Prior authorization may be required.
Tip: Ask your Cigna representative whether prior authorization is needed before purchasing so you can avoid claim issues.
UHC coverage depends heavily on your specific employer or individual plan. Some UHC plans explicitly include cranial prosthetics; others exclude them. Coverage for cancer-related hair loss tends to be stronger than for other diagnoses. Always verify before purchasing.
Tip: Review your Summary of Benefits document under "Prosthetics" or "Durable Medical Equipment" to see if cranial prosthetics are listed.
Humana's coverage for cranial prosthetics varies by plan. Medicare Advantage plans through Humana may include a wig or cranial prosthetic benefit not available through traditional Medicare. Check your specific Humana plan documents for DME or prosthetics coverage.
Tip: If you have a Humana Medicare Advantage plan, specifically ask about supplemental benefits for hair loss — some plans include it as an added benefit.
Tricare covers cranial prosthetics (wigs) for military members, retirees, and their dependents when hair loss is related to a covered medical condition or treatment. A physician prescription is required. Coverage is generally provided under the prosthetics and orthotics benefit.
Tip: Tricare typically requires the prosthetic to be obtained from an authorized provider. Contact Tricare to verify authorized supplier requirements.
Original Medicare Part B does not cover wigs or cranial prosthetics as a standard benefit. However, Medicare Advantage (Part C) plans offered by private insurers may include this as a supplemental benefit — coverage varies by plan and carrier. Check your Advantage plan's Summary of Benefits specifically.
Tip: If you have Medicare Advantage, call your plan and ask: "Does my plan include a supplemental benefit for cranial prosthetics or wigs?"
Medicaid coverage for cranial prosthetics varies by state. Some states — including Florida — cover cranial prosthetics for medically necessary hair loss under their Medicaid program. Coverage may require prior authorization and a physician's prescription. Contact your state's Medicaid office for specific details.
Tip: Florida Medicaid patients should ask specifically about "cranial prosthesis" under Florida Medicaid's DME benefit. Prior authorization is typically required.
Step-by-Step Process
How to Get Your
Claim Approved
Following these steps in order significantly increases the likelihood of a successful claim on the first submission.
1
Call Your Insurance Company First
Before seeing your doctor or purchasing anything, call the member services number on the back of your insurance card. Ask specifically: "Does my plan cover cranial prosthetics under HCPCS code A9282?" Write down the representative's name, the date of the call, and a reference number. This protects you if the claim is later disputed.
Ask also: "Is prior authorization required?" and "What is my plan's annual maximum for this benefit?"
2
Ask Your Doctor for a Prescription and Letter of Medical Necessity
Visit your oncologist, dermatologist, or primary care physician and request two things: (1) a prescription for a cranial prosthesis — not a "wig" — and (2) a Letter of Medical Necessity explaining why the prosthetic is medically required. The letter should include your diagnosis, your ICD-10 diagnosis code, and a statement that hair loss is a direct result of your medical condition or treatment.
Show your doctor the prescription template below if needed — many doctors are unfamiliar with the exact language required.
3
Get Prior Authorization (If Required)
If your insurer requires prior authorization, submit your doctor's prescription and Letter of Medical Necessity to your insurance company before purchasing. Prior authorization must be obtained in advance — it cannot be applied retroactively in most cases. Allow 5–10 business days for processing.
4
Purchase Your Cranial Prosthetic
Once you have authorization (or confirmed you don't need it), purchase your unit. The House of Postiche provides all patients with an itemized receipt and a clinical product description formatted specifically for insurance submission — identifying the unit as a "cranial prosthesis" with HCPCS code A9282.
5
Submit Your Claim
Submit the following documents together to your insurance company: (1) completed claim form, (2) physician prescription for cranial prosthesis, (3) Letter of Medical Necessity, (4) itemized receipt from The House of Postiche, (5) prior authorization number (if applicable). Keep copies of everything.
Submit via certified mail or your insurer's online portal so you have proof of submission date.
Billing Codes
The Codes That Matter
Using the correct billing codes on your claim is essential. These are the codes your doctor and your insurance company need to see.
HCPCS Code
A9282
Wig / Cranial Prosthesis, any type — the primary billing code for insurance claims
ICD-10 — Chemo Hair Loss
Z51.11
Encounter for antineoplastic chemotherapy — use when hair loss is chemo-related
ICD-10 — Alopecia Areata
L63.9
Alopecia areata, unspecified — use for alopecia areata diagnosis
ICD-10 — Drug-Induced
L65.8
Other specified nonscarring hair loss — for drug or treatment-induced alopecia
Your doctor will know which ICD-10 code applies to your specific diagnosis. Share these codes with them so the prescription is formatted correctly for your insurer.
Prescription Template
What Your Doctor's
Letter Should Say
Many physicians are unfamiliar with the exact language required for insurance-approved cranial prosthetic prescriptions. You can print and bring this template to your appointment.
To Whom It May Concern,
I am writing to certify that [Patient Full Name], Date of Birth [DOB], is under my care for [Diagnosis — e.g., breast cancer requiring chemotherapy / alopecia areata / alopecia totalis].
As a direct result of [their medical condition / chemotherapy treatment / radiation therapy], this patient has experienced significant hair loss and requires a cranial prosthesis for medical and psychological wellbeing. This is medically necessary and not merely cosmetic.
I am prescribing one (1) cranial prosthesis, HCPCS code A9282, for this patient. Please process coverage accordingly.
Sincerely,
[Physician Signature]
[Printed Name] · [Credentials] · [Date] · [NPI Number]
This template is provided for guidance only. Your physician may modify the language as clinically appropriate. The House of Postiche can provide a printed template upon request — contact us at support@mypostiche.com.
Flexible Spending
FSA & HSA Eligible
Even if your insurance plan does not cover cranial prosthetics, you may be able to use pre-tax FSA or HSA funds to pay for your unit.
Flexible Spending Account (FSA)
Cranial prosthetics are generally eligible for FSA reimbursement as a qualified medical expense under IRS Publication 502. You will need a prescription from your doctor and an itemized receipt from The House of Postiche identifying the product as a cranial prosthesis.
Submit through your FSA administrator's portal with your prescription and receipt attached.
Health Savings Account (HSA)
HSA funds can also be used to purchase a cranial prosthetic as a qualified medical expense. Like FSA, a physician prescription is recommended for documentation purposes.
HSA funds never expire — you can save receipts and reimburse yourself at any time. Keep your prescription and purchase receipt on file.
If Your Claim Is Denied
Don't Give Up — Appeals Work
A first-time denial is not the end. Many claims are approved on appeal. Under the Affordable Care Act, you have the right to appeal any denied claim.
Steps to Take After a Denial
You have the right to appeal. The denial letter must include the reason for denial and instructions for appealing. Act quickly — most plans have a 30–180 day window to file an appeal. Follow these steps:
- Request a written explanation of the denial and the specific policy language used to justify it
- Ask your doctor to write a stronger, more detailed Letter of Medical Necessity specifically addressing the denial reason
- Include any supporting medical records, diagnosis documentation, and treatment history
- Reference the term "cranial prosthesis" (not "wig") in every piece of documentation
- If the internal appeal fails, request an external independent review — this is your legal right under the ACA
- Contact The House of Postiche for additional documentation support: support@mypostiche.com
We're Here to Help
Questions About Your Coverage?
Our team assists approved patients with insurance documentation, Letters of Medical Necessity formatting, and claim resubmission support. You don't navigate this alone.