Collection: Medical Wigs (Cranial Prosthetics) Legal Information

This legislative bill mandates that, effective from January 1, 2025, all health care service plan contracts or health insurance policies newly issued, amended, or renewed must include coverage for cranial prostheses, defined within the context of this bill, for individuals who are experiencing either permanent or temporary medical hair loss. It specifies that a licensed health care provider must prescribe the cranial prosthesis as part of an individual's treatment for a diagnosed health condition, chronic illness, or injury, following the criteria detailed in the bill. Coverage is capped at one prosthesis per 12 months, with a financial limit of $750 for each coverage instance. It is important to note that this requirement does not extend to specialized health care service plans or specialized health insurance policies. Additionally, non-compliance with these stipulations by a health care service plan is considered a criminal offense, thereby instituting a state-mandated local program.

Moreover, the bill integrates coverage for cranial prostheses under the Medi-Cal program, which provides health care services to qualified low-income individuals and is partly governed by federal Medicaid program provisions, applying the same conditions regarding provider prescription, frequency of coverage, and coverage amount. This inclusion will take effect from January 1, 2025, and does not extend to specialized health care service plans.

The California Constitution obliges the state to compensate local agencies and school districts for certain state-mandated costs. Although statutory provisions are in place for such reimbursements, this bill clarifies that no reimbursement is necessitated by this act for a specified reason. The bill has passed with a majority vote, does not involve appropriation, is subject to fiscal committee approval, and constitutes a state-mandated local program.

The patient's diagnosis must include health conditions such as: chronic illness, or injury, including, but not limited to, alopecia areata, alopecia medicamentosa, scarring alopecia, and lupus. For purposes of this section, “cranial prosthesis” means a wig or hairpiece.
The contract provides coverage for a cranial prosthesis to line 16 an individual enrollee or subscriber no more frequently than once line 17 every 12 months. 

The people of the State of California do enact as follows:

 line 1 SECTION 1. Section 1367.651 is added to the Health and
 line 2 Safety Code, to read:
 line 3 1367.651. (a)  A health care service plan contract issued,
 line 4 amended, or renewed on and after January 1, 2025, shall cover
 line 5 cranial prostheses for individuals experiencing permanent or
 line 6 temporary medical hair loss, in accordance with subdivision (b).
 line 7 (b)  Coverage under this section shall meet all of the following
 line 8 requirements:
 line 9 (1)  A licensed provider prescribes the cranial prosthesis for an
 line 10 enrollee’s or subscriber’s course of treatment for the diagnosed
 line 11 health condition, chronic illness, or injury, including, but not
 line 12 limited to, alopecia areata, alopecia medicamentosa, scarring
 line 13 alopecia, and lupus. For purposes of this section, “cranial
 line 14 prosthesis” means a wig or hairpiece.
 line 15 (2)  The contract provides coverage for a cranial prosthesis to
 line 16 an individual enrollee or subscriber no more frequently than once
 line 17 every 12 months. 

 1 (3)  The coverage is limited to seven hundred fifty dollars ($750)
 line 2 for each instance of coverage, and shall be subject to any
 line 3 cost-sharing requirements that are otherwise applicable under the
 line 4 health care service plan contract.
 line 5 (c)  This section shall not apply to specialized health care service
 line 6 plans.
 line 7 SEC. 2. Section 10123.811 is added to the Insurance Code, to
 line 8 read:
 line 9 10123.811. (a)  A health insurance policy issued, amended, or
 line 10 renewed on and after January 1, 2025, shall provide coverage for
 line 11 cranial prostheses for individuals experiencing permanent or
 line 12 temporary medical hair loss, in accordance with subdivision (b).
 line 13 (b)  Coverage under this section shall meet all of the following
 line 14 requirements:
 line 15 (1)  A licensed provider prescribes the cranial prosthesis for an
 line 16 insured’s or policyholder’s course of treatment for the diagnosed
 line 17 health condition, chronic illness, or injury including, but not limited
 line 18 to, alopecia areata, alopecia medicamentosa, scarring alopecia,
 line 19 and lupus. For purposes of this section, “cranial prosthesis” means
 line 20 a wig or hairpiece.
 line 21 (2)  The contract provides coverage for a cranial prosthesis to
 line 22 an individual insured or policyholder no more frequently than once
 line 23 every 12 months.
 line 24 (3)  The coverage is limited to seven hundred fifty dollars ($750)
 line 25 for each instance of coverage, and shall be subject to any
 line 26 cost-sharing requirements that are otherwise applicable under the
 line 27 health insurance policy.
 line 28 (c)  This section shall not apply to specialized health insurance
 line 29 policies.
 line 30 SEC. 3. Section 14132.65 is added to the Welfare and
 line 31 Institutions Code, to read:
 line 32 14132.65. (a)  Commencing January 1, 2025, cranial prostheses
 line 33 for individuals experiencing permanent or temporary medical hair
 line 34 loss are a covered benefit, in accordance with subdivision (b).
 line 35 (b)  Coverage under this section shall meet all of the following
 line 36 requirements:
 line 37 (1)  A licensed provider prescribes the cranial prosthesis for a
 line 38 beneficiary’s course of treatment for a diagnosed health condition,
 line 39 chronic illness, or injury including, but not limited to, alopecia
 line 40 areata, alopecia medicamentosa, scarring alopecia, and lupus. For
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— 3 — AB 2668
 line 1 purposes of this section, “cranial prosthesis” means a wig or
 line 2 hairpiece.
 line 3 (2)  Coverage for a cranial prosthesis is provided to an individual
 line 4 beneficiary no more frequently than once every 12 months.
 line 5 (3)  Coverage is limited to seven hundred fifty dollars ($750)
 line 6 for each instance of coverage.
 line 7 (c)  This section shall not apply to specialized health care service
 line 8 plans.
 line 9 SEC. 4. No reimbursement is required by this act pursuant to
 line 10 Section 6 of Article XIIIB of the California Constitution because
 line 11 the only costs that may be incurred by a local agency or school
 line 12 district will be incurred because this act creates a new crime or
 line 13 infraction, eliminates a crime or infraction, or changes the penalty
 line 14 for a crime or infraction, within the meaning of Section 17556 of
 line 15 the Government Code, or changes the definition of a crime within
 line 16 the meaning of Section 6 of Article XIII B of the California
 line 17 Constitution. 

Link to California Assembly Bill AB 2668

https://www.chbrp.org/sites/default/files/bill-documents/AB2668/20230AB2668_99_0.pdf

When obtaining a medical prescription, the most commonly used codes are A9282 (synthetic wig) and L8499 (human hair wig). Ensure your doctor writes the Rx for a 'Medical Hair Prosthesis' or 'Cranial Prosthesis” (NOT a wig), and make sure they include your diagnosis code. If your prescription states a "wig", it will be denied since this word is deemed a fashion item and not a medical necessity.