How to Get Your Insurance to Pay for a Cranial Prosthesis: A Step-by-Step Guide
For many, a wig is a fashion choice. But when you are facing hair loss due to chemotherapy, alopecia, or other medical conditions, it is a medical necessity.
The good news? Most insurance companies cover between 80% and 100% of the cost of a wig—provided you stop calling it a "wig" and start calling it a Cranial Prosthesis.
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Step 1: The "Golden Rule" of Terminology
Insurance companies almost never pay for "wigs." In their eyes, a wig is a cosmetic accessory. To get reimbursed, you must use the medical term: Cranial Prosthesis.
When you speak to your insurance provider, always ask: "Does my policy cover a Cranial Hair Prosthesis for medical hair loss?"
Key Medical Codes You Need to Know:
HCPCS Codes (Procedure Codes): These tell the insurance company what you bought.
A9282: Wig, any type.
S8095: Wig (specific to some private insurers).
ICD-10 Codes (Diagnosis Codes): These tell them why you need it. Common codes include L63.9 (Alopecia Areata) or Z51.11 (Chemotherapy).
Step 2: Get Your Prescription
You cannot just buy a wig and send the receipt. You need a paper trail that starts with a doctor. Schedule an appointment with your dermatologist or oncologist.
Your prescription MUST include:
The words "Cranial Prosthesis" (not wig).
A valid ICD-10 Diagnosis Code.
Your doctor’s NPI (National Provider Identifier) number.
A Letter of Medical Necessity (optional but highly recommended) explaining how the hair loss is affecting your mental health or daily functioning.
Pro Tip: You can now get your medical consultation and prescription from the comfort of your home. We partner with specialized telemedicine providers who understand the exact requirements for insurance reimbursement.
Step 3: Shopping with a "Medical Invoice"
When you buy your prosthesis, you cannot use a standard retail receipt. You need an Itemized Medical Invoice from the wig boutique or salon.
Ensure the invoice includes:
The seller's Federal Tax ID Number.
The term "Cranial Prosthesis."
The HCPCS code (A9282).
Pro Tip: TruVu Beauty is familiar with insurance requirements and creates itemized medical invoices for all purchases!
Step 4: Submitting the Claim
Once you have your prosthesis, your prescription, and your medical invoice, it’s time to file.
Download your insurer's Claim Form (usually found on their website under "Member Forms").
Attach your documents: The prescription, the letter of necessity, and the itemized invoice.
Include a Personal Letter: Write a short, emotional note describing the impact hair loss has on your life.
Optional: Include a photo of yourself without hair to prove the medical nature of the claim.
Step 5: What to do if you are Denied
Do not panic if your first claim is denied. Insurance companies often deny the first attempt by default.
Ask for a formal reason in writing.
File an Appeal: Request a review by a Medical Review Board.
Highlight Exclusions: If they say "wigs are excluded," remind them that this is a prosthetic device for a medical condition, comparable to a prosthetic limb.
Summary Checklist
[ ] Prescription for "Cranial Prosthesis" obtained.
[ ] Diagnosis code (ICD-10) included on Rx.
[ ] Itemized invoice from the seller with Tax ID.
[ ] Insurance claim form completed.
[ ] Copies made of everything for your records.
Financial Alternatives
If your insurance absolutely will not cover it, remember:
HSA/FSA: You can usually use your Health Savings Account to pay for a medical wig tax-free.
Tax Deduction: If your medical expenses exceed 7.5% of your income, a cranial prosthesis is a deductible medical expense.
Grants: Organizations like the American Cancer Society or the National Alopecia Areata Foundation (NAAF) offer vouchers for those in need.
