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 documents will be used to determine your coverage.
Prior authorization is not required for cranial reshaping helmets/bands, or for protective helmets post craniotomy/craniectomy.
Protective Helmets may be covered post craniotomy/craniectomy subject to the indications listed below and per your plan documents.
Indications that are covered
Cranial reshaping helmets or bands are covered for children when:
- The child's skull has not responded to repositioning, and
- When ordered by the attending physician for one of the following diagnoses:
- Moderate to severe plagiocephaly; or
- Brachycephaly; or
- Scaphocephaly; or
- Craniosynostosis and has recently undergone a surgical cranial reshaping surgery; and
- The child is less than 18 months of age.
Protective helmets are covered post craniotomy/craniectomy for members when the bone flap is absent for any indication.
Indications that are not covered
- Cranial reshaping helmets or bands which are not FDA approved for the appropriate indication.
- Cranial reshaping helmets or bands are not covered for use in children over 18 months of age.
- Cranial reshaping helmets or bands are not covered for children with hydrocephalus or for preoperative treatment in craniosynostosis.
- Protective helmets, including but not limited to bicycle, ski, skateboarding and motorcycle helmets are not covered.
- Helmets that primarily have customary uses other than medical treatment also are not covered.
Brachycephaly occurs when the coronal bones or sutures of a baby’s head fuse together or close too early. This leads to the back of the head becoming flattened, causing the head to widen, and occasionally the forehead bulges out (called “bossing”). Mild, temporary brachycephaly can also occur as a positional deformity without fusion of the coronal bones in infants who are placed on their backs to sleep. This form is also especially common in babies who suffer from hypotonia (low muscle tone) in infancy.
Cranial reshaping helmet or band is a device that is custom molded to reshape or remodel the baby's head. The device allows 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.
Craniectomy is a neurosurgical procedure that involves removing a portion of the skull in order to relieve pressure on the underlying brain.
Craniotomy is a cut that opens the cranium. During this surgical procedure, a section of the skull, called a bone flap, is removed to access the brain underneath. The bone flap is usually replaced after the procedure with tiny plates and screws.
Non-synostotic plagiocephaly (sometimes called deformational or positional 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.
Scaphocephaly (or sagittal synostosis) is the most common of the craniosynostosis conditions. It affects the main suture on the very top of the head. The early fusing of these bones forces the head to grow long and narrow, instead of wide. Babies with this type tend to have a broad forehead. It is more common in boys than girls.
Torticollis is sometimes referred to as "wry neck." Torticollis is a condition where the muscles of the neck are tight on one side causing a twisting or pulling effect, which pulls the head out of its appropriate position.
If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all inclusive.
The services associated with these codes DO NOT require prior authorization:
Cranial remolding orthotic, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)
Note: A protective helmet (Codes A8000 – A8004) is not a cranial remolding device.
Helmet, protective, soft, prefabricated, includes all components and accessories
Helmet, protective, hard, prefabricated, includes all components and accessories
Helmet, protective, soft, custom fabricated, includes all components and accessories
Helmet, protective, hard, custom fabricated, includes all components and accessories
Soft interface for helmet, replacement only
CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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.
- Eberle, N. A., Stelnicki, E. J., & Boland, B. (2015). Efficacy of conservative and cranial orthotic therapy in over 4000 patients treated for positional plagiocephaly over a five-year period. Plastic and Reconstructive Surgery, 136(4S), 5-6. Copyright: ©2015 American Society of Plastic Surgeons. doi: 10.1097/01.prs.0000472276.69180.67
- American Academy of Orthotists and Prosthetists. (n.d.) Executive Summary on Remolding Helmets. Washington, DC: Author. Available from http://c.ymcdn.com/sites/www.oandp.org/resource/resmgr/Files/Policy_Statements/Executive-Summary-on-Remoldi.pdf?hhSearchTerms=%22executive+and+summary%22
- U.S. Food and Drug Administration (2016), Title 21: Chapter I: Subchapter H: 21CFR882.5970 Cranial orthosis.
- Grigsby, K. (2009). Cranial remolding helmet treatment of plagiocephaly: Comparison of results and treatment length in younger versus older infant populations. Journal of Prosthetics and Orthotics, 21(1), 55-63
- Hayes, Inc. Hayes Medical Technology Directory Report. Cranial Orthotic Devices for the Treatment of Positional Cranial Deformity. Lansdale, PA: Hayes, Inc.; July, 2014. Reviewed July, 2016.
- Kelly, K. M., Littlefield, T. R., Pomatto, J. K., Ripley, C. E., Beals, S. P., & Joganic, E. F. (1999). Importance of early recognition and treatment of deformational plagiocephaly with orthotic cranioplasty. The Cleft Palate-Craniofacial Journal, 36(2), 127-130. doi: http://dx.doi.org/10.1597/1545-1569(1999)036<0127:IOERAT>2.3.CO;2
- Paquereau, J. (2013). Non-surgical management of posterior positional plagiocephaly: Orthotics versus repositioning. Annals of Physical and Rehabilitation Medicine, 56(3), 231–249. doi: 10.1016/j.rehab.2012.12.005
- Tamber, M. S., Nikas, D., Beier, A., Baird, L. C., Bauer, D. F., Durham, S., … Flannery, A. M. (2016). Congress of Neurological Surgeons systematic review and evidence-based guideline on the role of cranial molding orthosis (helmet) therapy for patients with positional plagiocephaly. Neurosurgery-online, 79(5), E632-E633.
- Teichgraeber, J. F., Ault, J. K., Baumgartner, J., Waller, A., Messersmith, M., Gateño, J., … Xia, J. (2002). Deformational posterior plagiocephaly: Diagnosis and treatment. The Cleft Palate-Craniofacial Journal, 39(6), 582-586. doi: http://dx.doi.org/10.1597/1545-1569(2002)039<0582:DPPDAT>2.0.CO;2