Wigs covered by your benefits.

Original Medicare (Parts A and B) does not cover wigs or cranial prostheses, even when prescribed for chemotherapy-related hair loss — they are classified as not medically necessary under current CMS rules. There are two practical workarounds. First, many Medicare Advantage plans (Part C) include a cranial prosthesis or extra-benefits allowance — call your plan, ask specifically about 'cranial prostheses for chemotherapy-induced alopecia,' and get the answer in writing. Second, even without plan coverage, a cranial prosthesis remains an eligible medical expense: it can be paid with HSA funds and may be deductible under IRS Publication 502 if you itemize. Bring your Medicare card to your Dorin consultation and we'll help you read the benefit language before you commit to anything.

Insurance reimbursement for a cranial prosthesis varies widely by plan. Many private insurers cover a set benefit — commonly $150 to $500 per plan year — while some pay a percentage after your deductible and others, including plans common in Florida, exclude wigs from the contract outright. Plans that cover durable medical equipment often process cranial prosthesis claims under that benefit. Three things move a claim toward full payment: a physician's prescription written for a 'cranial prosthesis' (not a 'wig'), an itemized receipt with the correct billing code (HCPCS A9282 — Dorin provides this), and pre-authorization where your plan requires it. Call the member services number on your card, ask whether a 'cranial prosthesis' is covered or excluded, and request the requirements in writing before your fitting. Approved claims typically pay out within 2 to 6 weeks.

Yes — you can use FSA or HSA funds for a cranial prosthesis even if you have no insurance coverage at all. Eligibility is separate from insurance: IRS Publication 502 counts a wig as a medical expense when it is purchased on the advice of a physician for the mental health of a patient who has lost their hair from disease — chemotherapy, alopecia, thyroid disease, or another diagnosis. That makes your physician's advice the thing that matters, even when no insurer is involved, so get the prescription first. You can then pay directly with your FSA or HSA card at the time of service — no reimbursement claim, no waiting. Keep the prescription and Dorin's itemized receipt in case your administrator requests substantiation, which some do routinely. For 2026 you can set aside up to $3,400 in a health FSA (with up to $680 carrying into next year if your plan allows it), or up to $4,400 in an HSA for self-only coverage and $8,750 for a family — in most cases more than enough to cover a prosthesis outright. One planning note: FSA funds usually expire at the end of the plan year, so if your balance is about to reset, scheduling the fitting before year-end protects the benefit.

Dorin does not bill insurance carriers directly — you pay for your piece and submit the claim yourself, and the process still works smoothly because we hand you everything a claims department expects to see: an itemized receipt listing the piece as a 'cranial prosthesis' with the billing code (HCPCS A9282), supporting documentation, and a Letter of Medical Necessity when your plan requires one. Your physician provides the prescription and diagnosis code. With that package, most clients find submission straightforward — typically one claim form and a few uploads through your insurer's member portal. If your claim comes back with questions, bring us the letter: we've guided hundreds of clients through resubmissions and know the language reviewers look for.

Most plans that cover cranial prostheses allow one per plan year, though the details differ: some allow one per hair-loss incident, some one every 12 to 24 months, and a few tie the benefit to your diagnosis — for example, a new benefit period for each course of treatment. Your Summary of Benefits and Coverage (SBC) states the limit — search it for 'prosthesis' or 'wig' — or call member services and ask directly. If you need a replacement before your benefit renews, FSA and HSA funds can cover the additional piece, since IRS eligibility has no annual-count limit. A well-maintained human hair prosthesis from Dorin typically lasts 2 to 5 years, so most clients stay well within their plan's replacement cycle.

The active HCPCS code is A9282 ('wig, any type'), and it is the only code currently in use for a medical wig — UnitedHealthcare's Oxford wig policy, for one, names A9282 as the single applicable code. You may still see S8095 on older billing guides, hospital handouts, and patient forums; that code was deleted from HCPCS effective January 1, 2006 and superseded by A9282, so submitting under it today will hold up your claim. A code alone isn't enough either: a clean claim pairs A9282 with your physician's prescription and the diagnosis code for your condition, which your doctor provides. Every itemized receipt from Dorin lists the piece as a cranial prosthesis with A9282, so your paperwork arrives the way claims departments expect to see it. If your plan requires pre-authorization, request it before your fitting and keep the authorization number with your claim.

No — the Affordable Care Act does not require health plans to cover cranial prostheses at the federal level. Coverage is decided plan by plan, and by state law where a state mandate exists. A handful of states require insurers to cover wigs for medical hair loss, but Florida currently has no such mandate — so in South Florida, coverage depends entirely on your specific policy. The good news: many private plans do reimburse a cranial prosthesis when it is prescribed for a diagnosed condition and submitted with the right documentation. Call the member services number on your card, ask specifically about 'cranial prosthesis coverage,' and request the answer in writing. If your plan declines, you can still use FSA or HSA funds, which qualify independently of insurance under IRS Publication 502.

No — and unlike private insurance, there is no self-submit path. Wigs and cranial prostheses do not appear in Florida Medicaid's orthotic and prosthetic benefit, and A9282 is not on the 2026 Florida Medicaid DME fee schedule, so there is no covered benefit to claim. Florida Medicaid also pays only enrolled providers, and federal rules limit direct payment to a member to physician and dentist services — so paying out of pocket and submitting for reimbursement, the way you would with a commercial plan, is not available here. What you can do: Florida rule expressly allows a Medicaid member to pay privately for a service Medicaid does not cover, and some Statewide Medicaid Managed Care plans list extra benefits beyond the standard package, so one call to the member services number on your card is worth making. If neither route works, ask us at your consultation about nonprofit programs that help patients with medical wigs — and get the physician's prescription either way, since it documents medical necessity for any funding source you end up using.

A Letter of Medical Necessity (LMN) is a short, signed statement from your physician explaining that a cranial prosthesis is medically necessary to treat your specific diagnosis — not a cosmetic purchase. It typically includes your diagnosis, the recommended treatment (a cranial prosthesis), and the physician's signature and credentials. Some insurers require an LMN in addition to a prescription before they reimburse; some FSA and HSA administrators ask for one as well. Dorin's team prepares the supporting documentation at your fitting, and your physician signs it. If your plan requires an LMN, request it at the same appointment where you get your prescription — it saves a second trip and keeps your claim moving.