Use of an adjustable cranial orthosis may be considered medically necessary following cranial vault remodeling surgery for synostosis.
Use of an adjustable cranial orthosis for synostosis in the absence of cranial vault remodeling surgery is considered investigational.
Use of an adjustable cranial orthosis as a treatment of persistent plagiocephaly or brachycephaly without synostosis may be considered medically necessary when all of the following conditions have been met:
the individual is between 3 and 18 months old
documented failure of conservative therapy (repositioning and physical therapy) of at least 2 months duration
the individual has a cephalic index that is at least two standard deviations above or below the mean for the appropriate gender and age.
Use of an adjustable cranial orthosis is considered investigational for all other indications not outlined above.
(See below for discussion of use of an adjustable cranial orthosis as a reconstructive service.)
