Payer PolicyActive
Cranial Hair Prostheses - DME.CU.107.A
EVICORE-DME-2346A5FF
EviCore by Evernorth
Effective: November 15, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Cranial hair prostheses (HCPCS A9282) are covered for hair loss from burns causing permanent alopecia, chemotherapy, congenital baldness, medication- or infection-induced hair loss unresponsive to other treatment, lupus, radiation therapy, traumatic injury, and other documented medical conditions. The provided policy excerpt lists no explicit exclusions, limitations, frequency/age restrictions, prior treatment or documentation requirements.
Coverage Criteria Preview
Key requirements from the full policy
"Burns causing permanent alopecia"
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