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HealthPartners

Coverage criteria policies

Wigs

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.

Administrative Process

Prior authorization is required for the purchase of a wig.

Coverage

One standard wig per benefit year is generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

One standard wig is covered per calendar year for hair loss resulting from alopecia areata.

Indications that are not covered

  1. Wigs are not covered for hair loss resulting from other health conditions, including, but not limited to aging, chemotherapy, or radiation therapy.
  2. Upgraded wigs, including braids, weaves, and those made from human hair.
  3. More than one standard wig per benefit year.
  4. Microfusion or other hair replacement technologies.

Definitions

Alopecia areata is an autoimmune skin disease resulting in the loss of hair on the scalp and elsewhere on the body. It usually starts with one or more small, round, smooth patches on the scalp and can progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis) (National Alopecia Areata Foundation).

Standard Wig is a hair prosthesis made of synthetic hair.

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.

Codes

Description

A9282

Wig, any type, each

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

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.

Vendor

Items must be received from a contracted vendor or pharmacy for in-network benefits to apply.

References

  1. Minnesota Statutes 2016, section 62A.28.

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Policy activity

  • 01/01/1994 - Date of origin
  • 01/01/2017 - Effective date
Review date
  • 01/2017

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