Other Services
Chapter 8
Section 12.1
Wigs Or Hairpiece
Issue Date: April
19, 1983
Revision: C-60,
March 13, 2020
1.0 HCPCS Procedure
Code
A9282
2.0 POLICY
2.1 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 2017
• $2,246 for 2018
• $2,295 for 2019
• $2,348
for 2020
3.0 EXCLUSIONS
The
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.
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