How to Write a Letter of Medical Necessity for a Cranial Prosthesis
If you are fighting for insurance coverage for a medical wig, the Letter of Medical Necessity (LMN) is your most powerful weapon. Without it, most insurance adjusters will classify your claim as "cosmetic" and deny it immediately.
An LMN is a formal document written by your physician that explains why a cranial prosthesis is a vital part of your treatment plan.
What Must Be Included in an LMN?
For an insurance company to take the letter seriously, it can't just be a note on a prescription pad. It needs to be a formal letter on the doctor's official letterhead containing these five specific elements:
1. The Correct Medical Terminology
The word "wig" should never appear alone. The letter must refer to the device as a Cranial Prosthesis. This classifies it as a durable medical equipment (DME) item, similar to a prosthetic limb or a brace.
2. The Diagnosis (ICD-10 Code)
Your doctor must list your specific diagnosis. Common codes include:
L63.9: Alopecia Areata, unspecified
L65.9: Non-scarring hair loss
Z51.11: Antineoplastic chemotherapy (hair loss due to cancer treatment)
3. The Functional Purpose
Insurance companies love to say wigs are for "vanity." Your doctor needs to counter this by stating the functional reasons you need the prosthesis, such as:
Scalp Protection: Protecting sensitive skin from UV rays and infection.
Thermoregulation: Helping the body maintain heat (we lose a significant amount of heat through the scalp).
Psychological Impact: Mitigating severe distress or depression caused by medical hair loss.
4. Length of Need
The letter should state how long you are expected to need the prosthesis (e.g., "expected duration of treatment is 12 months" or "condition is permanent").
5. The HCPCS Procedure Code
Including the billing code A9282 directly in the letter helps the insurance billing department process the claim faster.
Sample Letter of Medical Necessity Template
You can provide this template to your doctor to ensure they include all necessary details.
[Doctor’s Letterhead]
RE: Letter of Medical Necessity for [Patient Name] DOB: [Date of Birth] Policy Number: [Policy Number]
To Whom It May Concern,
[Patient Name] is currently under my care for [Specific Diagnosis] (ICD-10: [Code]). As a direct result of this medical condition/treatment, the patient is experiencing total alopecia.
I am prescribing a Cranial Prosthesis (HCPCS A9282). This is a medical necessity for this patient to protect the scalp and assist with the physiological and psychological effects of hair loss. This is not for cosmetic purposes but is a prosthetic replacement for a missing body part.
Please approve coverage for this medical device.
Sincerely,
[Doctor’s Signature & NPI Number]
Don't Have a Doctor Who Specializes in Hair Loss?
Many general practitioners are hesitant to write these letters because they aren't familiar with the specific insurance requirements for prosthetics.
This is where Telemedicine can help. Our partner telemedicine providers specialize in medical hair loss. They understand exactly what insurance companies are looking for and can provide a consultation and a signed Letter of Medical Necessity virtually.
