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    v1.0.30
    OpenPayerBilling CodesTemporary National Codes (Non-Medicare)HCPCS hcpcs-s1040-pediatric-cranial-remolding-orthosis-rigid-custom
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    HCPCS Level II S1040: Cranial Remolding Orthosis, Pediatric, Rigid

    HCPCS Level II code S1040 describes a custom-fabricated pediatric cranial remolding orthosis, rigid with a soft interface material, provided with fitting and adjustments; the service is an orthotic device fabrication and delivery typically supplied in an outpatient clinic or specialty orthotics/prosthetics facility for infants requiring cranial shape correction.

    For related coverage guidance, see recent payer policy updates: Medical Necessity Guidelines Non-Emergency Transportation, Non-Emergent Transportation Medical Policy, Non-Emergency Facility to Facility Transfers.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an infant aged 3–6 months referred by a pediatrician or pediatric neurosurgeon for evaluation of positional plagiocephaly or craniosynostosis after head shape asymmetry is noted at well-child visits. The clinical workflow begins with a history and physical exam documenting head shape, growth parameters, and developmental milestones. Imaging (often skull X-ray or CT when synostosis is suspected) and measurement (plagiocephaly severity scales or cranial index) are used to determine candidacy. When conservative measures (repositioning, tummy time, physical therapy) are insufficient and the infant remains within the optimal age window for orthotic remodeling, an orthotist performs a custom cranial scan or cast, fabricates a rigid cranial remolding orthosis with a soft interface, and provides initial fitting and caregiver education. Follow-up visits occur every 2–4 weeks for adjustments and monitoring of fit and tolerance until treatment goals are achieved or growth plateaus, at which point the device is discontinued and final outcome documented.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    70553Magnetic resonance imaging, brain (3D or with multiplanar), without and with contrast material; this is a placeholder description.Data not available in the input.
    99213Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexityUsed for routine follow-up visits for orthosis adjustments and monitoring.
    99070Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visitUsed to bill for additional non-covered supplies related to orthosis fitting if payer allows.
    97760Orthotic management and training, initial encounterUsed when documenting patient/caregiver training on orthosis application, removal, and skin care.
    99080Data not available in the input.Data not available in the input.

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    208600000X
    207SG0207X
    2279P1004X
    163WE0900X
    207LH0002X
    246W00000X
    246ZB0500X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    P07.30Preterm newborn, unspecified weeks of gestation
    P07.32Preterm newborn, gestational age 29 completed weeks
    P07.33Preterm newborn, gestational age 30 completed weeks
    P07.34Preterm newborn, gestational age 31 completed weeks
    Q02Microcephaly
    Q03.9Congenital hydrocephalus, unspecified
    Q04.8Other specified congenital malformations of brain
    Q67.3Plagiocephaly
    Q67.4Other congenital deformities of skull, face and jaw
    Q68.8Other specified congenital musculoskeletal deformities

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: Emergency & Medical Transportation1 / 3

    10 rows

    PolicyPayerEffective Date
    Medical Necessity Guidelines Non-Emergency TransportationMass General Brigham Health Plan2026-11-01
    Non-Emergent Transportation Medical PolicyHealth-New-England2026-11-01
    Non-Emergency Facility to Facility Transfershap_caresource_mi_coordinated_health2026-11-01
    Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policybcbsvermont2026-10-01
    Emergency Air/Water Ambulance Services Medical GuidelineWPS Health Insurance2026-10-01
    Non-Emergent Ambulance ServicesConnectiCare2026-09-11
    Fixed Wing Air Ambulance TransportCigna2026-08-15
    Air AmbulanceAmbetter Georgia2026-08-01
    Ambulance Services (for Tennessee Only)UnitedHealthcare2026-08-01
    Ambulance Services (for New Mexico Only)UnitedHealthcare2026-08-01

    Related Codes

    HCPCS-LEVEL-II-S2152-SOLID-ORGAN-TRANSPLANTATION-GLOBAL-CARE

    HCPCS Level II S2152: Solid Organ Procurement and Transplantation

    HCPCS-LEVEL-II-S2266-INDUCED-ABORTION-29-TO-31-WEEKS

    HCPCS Level II S2266: Induced Abortion, 29 to 31 Weeks

    HCPCS-LEVEL-II-S3630-EOSINOPHIL-COUNT-BLOOD-DIRECT

    HCPCS Level II S3630: Eosinophil Count, Blood, Direct

    HCPCS-LEVEL-II-S4017-INCOMPLETE-ART-CYCLE-CANCELLED-PRIOR-TO-STIMULATION

    HCPCS Level II S4017: Incomplete Cycle — Cancelled Prior to Stimulation

    HCPCS-LEVEL-II-S8055-ULTRASOUND-GUIDANCE-MULTIFETAL-REDUCTION-TC

    HCPCS Level II S8055: Ultrasound Guidance for Multifetal Pregnancy Reduction

    HCPCS-LEVEL-II-S8940-EQUESTRIAN-HIPPOTHERAPY-PER-SESSION

    HCPCS Level II S8940: Equestrian/Hippotherapy, Per Session

    HCPCS-LEVEL-II-S9024-PARANASAL-SINUS-ULTRASOUND

    HCPCS Level II S9024: Paranasal Sinus Ultrasound

    HCPCS-LEVEL-II-S9366-HOME-TPN-1-2L-PER-DAY-HOME-INFUSION

    HCPCS Level II S9366: Home Infusion TPN, 1–2 L/day

    HCPCS-LEVEL-II-S9446-GROUP-PATIENT-EDUCATION-NON-PHYSICIAN

    HCPCS S9446: Patient Education, Non-Physician Provider, Group, Per Session

    HCPCS-LEVEL-II-S9451-EXERCISE-CLASS-NON-PHYSICIAN-SESSION

    HCPCS S9451: Exercise Classes, Non-Physician Provider, Per Session

    Showing 1–10 of 532

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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