TRICARE Policy Manual 6010.60-M, April 1, 2015 Other Services Chapter 8 Section 12.1 Wigs Or Hairpiece Issue Date: April 19, 1983 Authority: 10 USC 1074(c) and 32 CFR 199.4(g)(41) Revision: C-52, September 20, 2019 1.0 HCPCS Procedure CodeA9282 2.0 POLICY2.1 Benefits may be extended in accordance with the allowable charge, for one wig (also known as cranial prosthesis) or hairpiece per beneficiary (lifetime maximum) when the attending physician certifies that alopecia has resulted from the treatment of a malignant disease and the beneficiary certifies that a wig or hairpiece has not been obtained previously through the U.S. Government (including the Department of Veterans Affairs/Veterans Health Administration (DVA/VHA)). 2.2 Allowable Charge. Effective January 1, 2011, the allowable charge may not exceed the Calendar Year (CY) rate specified in paragraph 2.3 per wig or hairpiece. If the wig or hairpiece purchased by the beneficiary exceeds this maximum amount, TRICARE shall reimburse only up to the allowable amount. This amount shall be updated annually by using the Consumer Price Index-Urban (CPI-U). The updated amount will be published in this section. 2.3 The allowable charge per wig or hairpiece may not exceed: • $2,213 for 2016 • $2,213 for 2017 • $2,246 for 2018 • $2,295 for 2019 3.0 EXCLUSIONSThe wig /cranial prosthesis or hairpiece benefit does not include coverage for the following: 3.1 Alopecia resulting from conditions other than treatment of malignant disease. 3.2 Maintenance, supplies, or replacement of the wig/cranial prosthesis or hairpiece. Statutory provisions limit these items to one furnished at the expense of the Government (i.e., prosthetic replacement provisions do not apply). 3.3 Hair transplants or any other surgical procedure involving the attachment of hair or a wig or hairpiece to the scalp. 3.4 Any diagnostic or therapeutic method or supply intended to encourage hair regrowth. - END -