Plagiocephaly and Craniosynostosis Treatment – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers cranial orthotic devices as medically necessary for infants after craniosynostosis surgery and for moderate-to-severe nonsynostotic (positional/deformational) plagiocephaly when InterQual CP clinical criteria are met, while surgical repair (CPT 21175) and orthosis repair/replacement are managed under separate policies and final coverage depends on the member-specific benefit plan. Key requirements: FDA Class II device controls including a prescription, intended age generally 3–18 months, and medical-record documentation per InterQual/member plan to demonstrate medical necessity.

"Cranial orthotic devices are proven and medically necessary for treating infants following craniosynostosis surgery"

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