2.0 POLICY
2.1 The
contractor shall reimburse 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
shall 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,
the contractor shall
reimburse only up to the allowable amount.
The Government
will update this amount
annually
by using the Consumer Price Index-Urban (CPI-U).
DHA
will publish the updated amount
in
this section.
2.3 The allowable
charge per wig or hairpiece may not exceed:
• $2,246
for 2018
• $2,295 for 2019
• $2,348 for 2020
• $2,388 for 2021
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.