Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses

This policy covers adjustable cranial orthoses (helmets or headbands) for positional plagiocephaly and as a postoperative adjunct following cranial vault remodeling for craniosynostosis. Coverage is limited to infants 3–18 months with persistent plagiocephaly/brachycephaly after ≥2 months of failed conservative therapy and a cephalic index ≥2 standard deviations (and to post‑op craniosynostosis cases), may include therapy/diagnostics/equipment to improve quality of life for children with clinical or genetic disorders causing low‑tone neuromuscular, neurological, or cognitive impairment, and is subject to the member’s benefit contract, state mandates, and fully insured plan election (not applicable to self‑insured/ASO); orthoses are not covered for mild or purely cosmetic asymmetry or for craniosynostosis without prior surgical remodeling.

"Use of adjustable cranial orthoses for positional plagiocephaly"