Medicare Advantage

Medical Policy

Title:

Hair Transplants and Cranial Prostheses (Wigs)

Policy #:

MA11.046c

Policy

In the absence of coverage criteria from applicable Medicare statutes, regulations, NCDs, LCDs, CMS manuals, or other Medicare coverage documents, this policy uses internal coverage criteria developed by the Company in consideration of peer-reviewed medical literature, clinical practice guidelines, and/or regulatory status.

HAIR TRANSPLANTS

When performed as a cosmetic service, hair transplants are not covered by the Company because cosmetic services are not covered by Medicare. However, hair transplants are considered medically necessary and, therefore, covered for the treatment of permanent hair loss that is caused by any of the following conditions:

Physical trauma (e.g., burns, lacerations)
Surgery (e.g., tumor removal)
Diseases that cause cicatricial (scarring) alopecia (e.g., discoid lupus erythematosus, scleroderma)

Hair transplants performed for indications other than those specified in the medical necessity criteria abo

ve are considered a cosmetic service. Services that are cosmetic are not covered by the Company because cosmetic services are not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

CRANIAL PROSTHESES (WIGS)

Cranial prostheses (wigs) are not covered by the Company because they are items not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

Guidelines

This policy is consistent with Medicare’s coverage determination for cranial prostheses (wigs). There is no Medicare coverage criteria addressing hair transplants.

BENEFIT APPLICATION

HAIR TRANSPLANTS
Subject to the terms and conditions of the applicable Evidence of Coverage, hair transplants are covered under the medical benefits of the Company’s Medicare Advantage products when the medical necessity criteria listed in this medical policy are met.

CRANIAL PROSTHESES/WIGS
Subject to the terms and conditions of the applicable Evidence of Coverage, cranial prostheses (wigs) are not eligible for payment under the medical benefits of the Company’s Medicare Advantage products because these services are considered not covered by Medicare.

Description

Alopecia (hair loss) can be caused by aging, hormonal changes, genetic predisposition, or circumstances such as disease or physical trauma. In most disorders of alopecia, the hair follicle is either normal but has an abnormal growth cycle, or it has been damaged. Hair transplants and cranial prostheses (wigs) are frequently used to treat hair loss.

COMMON TYPES OF ALOPECIA

ANAGEN EFFLUVIUM
Anagen effluvium is abnormal diffuse hair loss arising during the growth stage of the hair cycle that may leave the scalp partially or completely bald. The condition begins days to weeks after exposure to a chemotherapeutic agent. It is most apparent after 1 or 2 months after chemotherapy administration and is usually reversible with hair regrowth after cessation of the offending chemotherapeutic agent.

ANDROGENIC ALOPECIA
Androgenic alopecia is known as male-pattern baldness in men and female-pattern hair loss in women. It is the most common form of alopecia that results in permanent hair loss. Hair loss is mediated by a combination of genetic factors and levels of testosterone.

ALOPECIA AREATA
Alopecia areata is an autoimmune disease that is characterized by a localized area of complete hair loss that is usually in coin-shaped patches on the face, scalp or other areas of the body that normally grow hair. Thyroid abnormalities and pernicious anemia are frequently the underlying factors of alopecia areata. Alopecia areata encompasses the following types:

Patchy alopecia is circumscribed, oval shaped, flesh colored patches on any part of the body.
Alopecia totalis involves the entire scalp.
Alopecia universalis results in hair loss across the entire scalp, face (including eyebrows and eyelashes), plus the rest of the body (including pubic hair).
Diffuse alopecia areata results in sudden and unexpected thinning of the hair all over the scalp.
Ophiasis alopecia involves a unique pattern of hair loss that includes the sides and lower back of the scalp, called the occipital region, in the shape of a band.

TELOGEN EFFLUVIUM
Telogen effluvium is a form of hair loss characterized by hair thinning or an increase in hair shedding that arises during the resting stage of the hair cycle especially on the top of the scalp that usually happens after stress, a shock or traumatic event. It is a reactive process occurring more often in women, that resolves spontaneously when the underlying cause is eliminated. A list of inciting factors includes severe, chronic illnesses, pregnancy, high fever, malnutrition, endocrine disorders, severe infections, and emotional and physiologic stress.

CICATRICIAL (SCARRING) ALOPECIA
Cicatricial alopecia refers to a collection of rare hair loss disorders (e.g., folliculitis decalvans, pseudopelade) that result from a condition, such as an infection (e.g., herpes zoster), autoimmune disease ( e.g., discoid lupus erythematosus), sarcoidosis, scalp trauma (e.g., burns), or radiation therapy, that destroys the hair follicle without regrowth, and replaces it with scar tissue, causing permanent hair loss.

TRAUMATIC ALOPECIA
Traumatic alopecia is caused by cosmetic practices that damage hair follicles over time and has been linked to the use of brush rollers, curling irons, tight braiding and repetitive exposure to harsh hair chemicals or disorders such as trichotillomania (compulsive behavior involving the repeated plucking of hair).

HAIR TRANSPLANTS

Hair transplants involve transferring hair follicles from one body site to another for the treatment of conditions such as, but not limited to, alopecia or physical trauma.

There are several types of hair transplant techniques, which include but are not limited to: strip grafts (30 to 40 hairs), punch grafts (10 to 15 hairs), minigrafts (three or six hairs), and micrografts (one or two hairs).

CRANIAL PROSTHESES (WIGS)

A cranial prosthesis (wig) is a manufactured covering for the head that is made of natural or synthetic hair. The term "wig" also applies to hairpieces and similar manufactured coverings that are used to replace or supplement hair.

References

American Society for Dermatologic Surgery (ASDS). Hair transplants. [ASDS Web site]. 2019. Available at: https://www.asds.net./skin-experts/skin-treatments/hair-transplants. Accessed June 16, 2025.

American Society of Plastic Surgeons (ASPS). Hair replacement. [ASPS Web site]. 2020. Available at: http://www.plasticsurgery.org/Cosmetic-Procedures/Hair-Replacement.html. Accessed June 16, 2025.

Centers for Medicare & Medicaid Services. Medicare Managed Care Manual Chapter 4 - Benefits & Beneficiary Protections. Revised 04/22/2016. Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c04.pdf. Accessed June 16, 2025.

Cicatricial Alopecia Research Foundation (CARF). About cicatricial alopecia. [CARF Web site]. 2019. Available at: http://www.carfintl.org. Accessed June 16, 2025.

Hantash BM. Scarring alopecia. [Medscape Web site]. 02/26/2018. Updated 10/28/2022. Available at: http://emedicine.medscape.com/article/1073559-overview. Accessed June 16, 2025.

National Alopecia Areata Foundation (NAAF). Different types of alopecia areata. [NAAF Web site]. 2020. https://www.naaf.org/alopecia-areata/types-of-alopecia-areata. Accessed June 16, 2025.

Noridian Healthcare Solutions. Noncovered items list. Revised 12/19/2019. [Noridian Healthcare Solutions Web site]. Available at: https://med.noridianmedicare.com/web/jadme/search-result/-/view/2230703/noncovered-items. Accessed June 16, 2025.

Phillips TG, Slomiany WP, Allison R. American Family Physician. Hair loss: Common causes and treatment. [American Academy of Family Physicians (AAFP) Web site]. 09/15/2017. Available at: https://www.aafp.org/afp/2017/0915/p371.html. Accessed June 16, 2025.

Springer K, Brown M, Stulberg DL. Common hair loss disorders. Am Fam Physician. 2003 Jul 1;68(1):93-102.

Thiedke CC. Alopecia in women. American Family Physician. [American Academy of Family Physicians (AAFP) Web site]. 03/01/2003. Available at: https://www.aafp.org/pubs/afp/issues/2003/0301/p1007.html. Accessed June 16, 2025.

Venes D, Thomas CL, Taber CW, eds. Taber's Cyclopedic Medical Dictionary.19th ed. Philadelphia, PA: FA Davis Co; 2001.

Coding

CPT Procedure Code Number(s)

MEDICALLY NECESSARY

15775, 15776

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

See Attachment A.

HCPCS Level II Code Number(s)

NOT COVERED

A9282 Wig any type, each

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub

Coding and Billing Requirements

Cross Reference

Policy History

Revisions From MA11.046c:

08/06/2025

The policy has been reviewed and reissued to communicate the Company’s continuing position on Hair Transplants and Cranial Prostheses (Wigs).

10/01/2024

This policy has been identified for the ICD-10 code update, effective 10/01/2024.

The following ICD 10 codes have been deleted from this policy:

L66.8 Other cicatricial alopecia

The following ICD 10 codes have been added to this policy:

L66.81 Central centrifugal cicatricial alopecia
L66.89 Other cicatricial alopecia

Revisions From MA11.046b:

09/18/2024	The policy has been reviewed and reissued to communicate the Company’s continuing position on Hair Transplants and Cranial Prostheses (Wigs).
01/01/2024	Effective 01/01/2024 this policy applies to New Jersey Medicare Advantage (MA) lines of business.
02/22/2023	The policy has been reviewed and reissued to communicate the Company’s continuing position on Hair Transplants and Cranial Prostheses (Wigs).
06/02/2021	The policy has been reviewed and reissued to communicate the Company’s continuing position on Hair Transplants and Cranial Prostheses (Wigs).
05/20/2020	The policy has been reviewed and reissued to communicate the Company’s continuing position on Hair Transplants and Cranial Prostheses (Wigs).
09/09/2019	The version of this policy will become effective 09/09/2019. The policy has been updated to communicate the Company's continuing position on Hair Transplants and Cranial Prostheses (Wigs). The following ICD-10 diagnosis codes have been deleted from the policy: L63.0 Alopecia (capitis) totalis L63.1 Alopecia universalis L63.2 Ophiasis L63.8 Other alopecia areata L63.9 Alopecia areata, unspecified L64.0 Drug-induced androgenic alopecia L65.0 Telogen effluvium L65.1 Anagen effluvium L65.2 Alopecia mucinosa L65.8 Other specified nonscarring hair loss L65.9 Nonscarring hair loss, unspecified

Revisions From MA11.046a:

03/28/2018	The policy has been reviewed and reissued to communicate the Company’s continuing position on Hair Transplants and Cranial Prostheses (Wigs).
05/03/2017	The intent of this policy remains unchanged. The following code was added: S01.00XA Unspecified open wound of scalp, initial encounter

Revisions From MA11.046:

03/16/2016	The policy has been reviewed and reissued to communicate the Company’s continuing position on Hair Transplants and Cranial Prostheses (Wigs).
01/21/2015	The policy has been reviewed and reissued to communicate the Company’s continuing position on Hair Transplants and Cranial Prostheses (Wigs).
01/01/2015	This is a new policy.

Version Effective Date:

10/1/2024

Version Issued Date:

12/2/2024

Version Reissued Date:

8/6/2025