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Cranial reshaping helmet/band

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.

Administrative process

Prior authorization is not required for cranial reshaping helmets/bands.

Cranial reshaping helmets/bands are generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

Cranial reshaping helmets or bands are covered for children less than 12 months of age when the child's skull has not responded to repositioning and when ordered by the attending physician for the following diagnoses:

  1. Moderate to severe plagiocephaly; or
  2. Brachycephaly; or
  3. Scaphocephaly; or
  4. Craniosynostosis and has recently undergone a surgical cranial reshaping surgery; and
  5. The child is less than 12 months of age.

Indications that are not covered

  1. The cranial reshaping helmet or band must be FDA approved for the appropriate indication.
  2. Cranial reshaping helmets or bands are not covered for use in children over 12 months of age.
  3. Cranial reshaping helmets or bands are not covered for children with hydrocephalus or for preoperative treatment in craniosynostosis.

Asymmetry refers to a lack of proportion, or lack of sameness in both halves.

Cranial reshaping helmet or band is a device that is custom molded to reshape or remodel the baby's head. The devices allow normal growth of the brain while preventing further distortion of prominent areas of the cranium. The reshaping process occurs over a period of months. The helmet or band may be used to reshape an asymmetric deformity or as a postoperative measure to make sure that symmetry is maintained following cranial surgery.

Craniosynostosis is a condition where the bones or sutures of a baby's head fuse together or close too early, which may lead to an asymmetrically shaped skull or head. Surgical treatment is usually required to reshape the bones.

Non-synostotic plagiocephaly refers to a condition where asymmetry forms in the shape of a baby's head before the cranium bones fuse together. This occurs when excess pressure is applied to an area of the cranium, such as may occur in babies born prematurely, or babies who are crowded in the womb, drop into the mother's pelvis too early, or even for babies who frequently rest in the same position.

Plagiocephaly describes a head that is not shaped the same on both sides. Most commonly the asymmetry is a flattened or bulging area on the side or back of the head.

Torticollis is sometimes referred to as "wry neck." Torticollis is a condition where the muscles of the neck are tight on one side cause a twisting or pulling effect, which pulls the head out of its appropriate position.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

S1040 - Cranial remolding orthotic, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Vendor

  • Items may be received from Gillette Children's Specialty HealthCare, or
  • Items may be received from an alternate vendor when referred by your primary physician or clinic

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.