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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.7 Orthotic and Prosthetic Services (CCP) : 2.7.3 Cranial Molding Orthosis

Cranial molding orthosis (procedure code S1040) may be a benefit for clients who are 3 through 12 months of age when one of the following applies:
The client presents with nonsynostotic (positional) plagiocephaly with an associated functional impairment including orofacial musculoskeletal or neurocognitive disorders, or there is documented evidence that the use of the cranial molding orthosis will modify or prevent the development of such impairments.
Muscular torticollis (wry neck) characterized by tight or shortened neck muscles that result in a head tilt or turn is often associated with the secondary development of positional plagiocephaly. Clients with positional plagiocephaly and muscular torticollis must have documentation of early, aggressive treatment (stretching, positioning, or physiotherapy) before consideration for cranial orthosis.

Texas Medicaid & Healthcare Partnership
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