Wig Insurance Reimbursement

Yes, a wig can often be reimbursed

When hair loss comes from a medical cause, a wig is not a beauty purchase. It is a cranial prosthesis, and many health plans reimburse some or all of the cost. Whether yours does depends on your specific plan, and the outcome usually comes down to whether the paperwork is right.

We cannot bill your insurance directly and we cannot guarantee what any plan will pay. What we can do is give you documentation that is correctly coded and complete, which is the part most people get wrong.

What a cranial prosthesis is

A cranial prosthesis is a custom made hair piece for medical hair loss. The wig itself is the same wig. The difference is how it is prescribed, described and coded. Insurers do not reimburse for a wig. They reimburse for a cranial prosthesis, which is why the wording on every document matters.

Qualifying causes commonly include chemotherapy and radiation, alopecia areata, totalis and universalis, thyroid conditions, lupus and other autoimmune disease, and permanent loss following surgery or burns.

What you need to submit

  1. A prescription from your doctor. It should read cranial prosthesis, not wig. It should include your diagnosis code and the reason for the hair loss. Any treating physician can write it, including your oncologist, dermatologist, endocrinologist or primary care doctor.
  2. An itemized superbill from us. Ours uses HCPCS code L8499, our provider NPI 1992577837, the date of service, and the amount paid. It contains no cosmetic or styling language, because a single word in the wrong place can get a claim denied.
  3. Proof of payment. Your receipt.
  4. Your plan's claim form. Most insurers call this an out of network or member reimbursement claim form. It is on your insurer's website.

The steps, in order

  1. Call your insurer before you buy. Ask whether your plan covers a cranial prosthesis under code L8499, what the benefit maximum is, how often it renews, and whether prior authorization is required. Write down the date, the representative's name and a reference number.
  2. Get the prescription written first. Some plans will not honor a prescription dated after the purchase.
  3. Get prior authorization if your plan requires it. Skipping this is the most common reason an otherwise valid claim is denied.
  4. Purchase your wig. We issue your superbill.
  5. Submit everything together. Claim form, prescription, superbill, receipt. Keep copies of all of it.
  6. If you are denied, appeal. Denials on cranial prostheses are frequently reversed on appeal, often because the first submission was coded or worded as a cosmetic item. Ask for the denial reason in writing and respond to that specific reason.

FSA and HSA

A wig for medical hair loss is generally an eligible expense under both. Most administrators want a Letter of Medical Necessity from your doctor on file. If you have funds sitting in an FSA, this is often the fastest route to using them, with no claim cycle and no waiting on a reimbursement check.

Medicare and Medi-Cal

Original Medicare does not cover cranial prostheses. Some Medicare Advantage plans include a supplemental benefit for them, so it is worth calling. Medi-Cal coverage is limited and plan specific. Ask before you assume either way.

What we provide

  • An itemized superbill coded as a cranial prosthesis, with our NPI and no cosmetic descriptors
  • A handout you can bring to your physician showing exactly how to word the prescription
  • Reissued documentation if your insurer asks for it in a different format

We are happy to prepare all of this whether you are buying in person in Los Angeles or virtually from anywhere.

Common questions

Do you bill my insurance directly?

No. You pay us and submit for reimbursement. This is standard for cranial prostheses and it is why the quality of your paperwork matters so much.

How much will my plan pay?

It varies widely. Some plans reimburse in full up to a set maximum, some pay a percentage, some cover one prosthesis per year or per lifetime. Only your insurer can tell you.

What if my doctor writes it as a wig?

Ask for it to be rewritten as a cranial prosthesis. Most physicians will do this without hesitation once they know it affects coverage.

Can I submit for a wig I already bought?

Sometimes, depending on your plan's filing deadline and whether a prescription existed at the time. Call and ask.

Start with a consultation

We will walk you through the documentation as part of your fitting. Book in Los Angeles or book virtually.

Also worth reading: wigs for alopecia and The Wig Blog.

This page is general information, not insurance or medical advice. Coverage depends entirely on your individual plan.