Physician Referral & Prescription
A printable cranial prosthesis referral form for your physician.
A little clarity. A little less worry.
Patient resources, insurance questions, and information for your care team—all in one place.
Insurance & HSA/FSA
A cranial prosthesis — sometimes called a medical wig — is a hair replacement designed for people experiencing hair loss from chemotherapy, radiation, alopecia, or other medical conditions and treatments. Unlike a fashion wig, it is measured and fitted to your head, built on a soft, breathable cap suited to sensitive scalps, and may be prescribed by your physician and covered by insurance as durable medical equipment.
Coverage varies by insurer and by plan. Before purchasing, ask whether your policy covers a cranial prosthesis, whether prior authorization is required, and what dollar or frequency limits apply. We provide documentation to support your claim but cannot guarantee reimbursement.
If your insurer requires a prescription, ask your physician about prescribing a “cranial prosthesis” for medical hair loss. Your insurer may request a diagnosis, medical-necessity documentation, or a specific billing code. Our referral form lists HCPCS A9282; confirm your plan’s requirements.
Original Medicare generally does not cover wigs, even when prescribed, though some Medicare Advantage plans offer an allowance. Medicaid coverage varies by state — Tennessee’s program has its own rules, so ask your plan directly whether a prescribed cranial prosthesis is a covered benefit. Whatever your coverage, we provide the documentation your plan asks for.
Eligibility and documentation requirements depend on the account and your circumstances. Check with your HSA or FSA administrator before purchasing. We can supply an itemized receipt and product description.
If possible, meeting before treatment begins helps us match your natural hair color, texture, density, and part. If hair loss has already started, recent photos can be helpful. You are welcome at any stage.
Download the Physician Referral & Prescription form below. It includes space for the diagnosis, prescription, and provider signature. Completed forms can be sent to tiffany@halocranial.com. Please do not submit personal health information through this website.
Take the information with you
A printable cranial prosthesis referral form for your physician.
Our approach, what to bring, and questions for your insurer.
A concise introduction to our practice and personalized care.
Questions about any of these materials? Email tiffany@halocranial.com.
Trusted patient education
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Visit resourceThis information is educational and does not replace guidance from your physician or insurer.
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