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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2 Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.10 Orthotic and Prosthetic Services (CCP) : 2.10.3 Cranial Molding Orthosis

Cranial molding orthosis (procedure code S1040) may be a benefit when all of the following criteria are met:
The limitation for procedure code S1040 is one device per lifetime.
The definition for cosmetic, as it applies to cranial molding orthosis, includes surgery or other services used primarily to improve appearance and not to restore or correct significant deformity resulting from disease, trauma, congenital or developmental anomalies, or previous therapeutic process.

Texas Medicaid & Healthcare Partnership
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