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    v1.0.31
    OpenPayerPolicy UpdatesDurable Medical Equipment (DME)Blue Cross Complete MI Wig Coverage Update | OpenP…
    Ask Trek AI about this page
    CurrentBlue Cross Complete of MichiganPolicy N/A

    Medicare Advantage Preferred Provider Organization Enhanced Benefit Policy

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    Coverage, payment, coding, and member cost sharing for wigs, wig stands, and wig-related adhesives under select Medicare Plus Blue Group PPO plans.

    Policy Summary
    PayerBlue Cross Complete of Michigan
    PolicyMedicare Advantage Preferred Provider Organization Enhanced Benefit Policy
    Policy CodePolicy N/A
    Change TypeRevised
    Effective DateJan 1, 2026
    Next Review DateN/A
    Key ActionVerify the member's plan benefit, authorization requirements, cost sharing, and remaining maximum before furnishing a wig.
    SourceLink
    POLICY UPDATE CHANGES

    The diagnosis list for State Health Plan Medicare Advantage PPO and University of Michigan was updated to include specified alopecia and hair-loss diagnoses.

    The UAW Retiree Medical Benefits Trust benefit was updated to have no diagnosis restrictions.

    The policy was transitioned to a new template and received approval from the Medicare Advantage Medical Director or delegated clinician.

    A9282Primary wig HCPCS code
    $300 lifetimeState Health Plan maximum
    $250 annuallyUAW maximum

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    100%University of Michigan coverage
    NoneFrequency limit

    Coverage Criteria

    State Health Plan and University of Michigan

    Covered for State Health Plan Medicare Advantage PPO and University of Michigan members when ALL of the following are met.

    Required criteria

    • Prescription: The wig is prescribed by a physician.

    • Qualifying hair loss

      • Hair loss is due to chemotherapy.
      • The member has alopecia or a disease that caused hair loss.

    UAW Retiree Medical Benefits Trust

    Covered for UAW Retiree Medical Benefits Trust members when ALL of the following are met.

    Required criteria

    • Prescription: The wig is prescribed by a physician.
    • Qualifying hair loss: Hair loss results from any medical condition or treatment.

    Plan-specific payment conditions

    Payment is subject to the member's selected enhanced benefit and the applicable plan maximum.

    Required payment conditions

    • Eligible plan: The member is enrolled in a participating Medicare Plus Blue Group PPO plan with the selected enhanced wig benefit.
    • Eligible provider and location: The item is furnished by an eligible provider at home. Eligible providers include DME suppliers, orthotists, prosthetists, and other sources.
    • Applicable plan maximum: Payment is limited to the applicable plan benefit maximum.

      State Health Plan Medicare Advantage PPO: 100% of the approved amount until the $300 lifetime limit is met. UAW Retiree Medical Benefits Trust: 100% of the approved amount up to a $250 annual maximum. University of Michigan: 100% of the approved amount, with no deductible, copay, or coinsurance.

    Original Medicare exclusion: Wigs of any type, wig stands, and wig-related adhesives are not covered under Original Medicare for any reason or condition.

    Medical Necessity Requirements

    Qualifying medical hair loss

    Medical necessity and benefit eligibility vary by plan group. A physician prescription is required for all listed plan groups.

    Plan-specific qualifying indication

    • State Health Plan Medicare Advantage PPO or University of Michigan

      • Hair loss is due to chemotherapy.
      • The member has alopecia or a disease that caused hair loss.
    • UAW Retiree Medical Benefits Trust: Hair loss results from any medical condition or treatment.

    Coding and Benefit Parameters

    Covered CPT/HCPCS CodesHCPCSCovered
    A4452Tape, waterproof, per 18 sq in.
    A4649Surgical supply; miscellaneous.
    A9282Wig, any type, each
    ICD-10 CodesICD-10
    L63.0Alopecia (capitis) totalis.
    L63.1Alopecia universalis.
    L63.2Ophiasis.
    L63.8Other alopecia areata.
    L63.9Alopecia areata, unspecified.
    L64.0Drug-induced androgenic alopecia.
    L64.8Other androgenic alopecia.
    L64.9Androgenic alopecia, unspecified.
    L65.0Telogen effluvium.
    L65.1Anagen effluvium.
    1–10 of 23
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    State Health Plan Medicare Advantage PPO benefit maximum
    Coverage amount100% of the approved amount
    Lifetime limit$300 lifetime limit
    UAW Retiree Medical Benefits Trust benefit maximum
    Coverage amount100% of the approved amount
    Annual maximum$250 annual maximum
    Frequency limit
    Frequency limit

    Provider Actions and Billing Risks

    Prior Authorization

    University of Michigan Prescription and Authorization

    For University of Michigan coverage, the wig prescription must be written by a physician. Prior authorization may also be required; verify the requirement before providing the wig.

    • University of Michigan benefit: 100% of the approved amount, with no deductible, copay, or coinsurance.
    • Confirm whether prior authorization is required for the member's plan.
    Documentation Required

    Obtain a Coverage Determination When Uncertain

    If there is any question about whether a wig, wig stand, adhesive, or related item is covered, obtain a coverage determination from Medicare Plus Blue before providing it to the member.

    • Do not rely on an Advance Beneficiary Notice of Noncoverage to transfer responsibility for a potentially covered item.

    Documentation Requirements

    Documentation Required

    Document the qualifying hair-loss indication

    Obtain and retain a physician prescription for the wig. Documentation must identify the member’s plan-specific qualifying hair-loss indication.

    • State Health Plan Medicare Advantage PPO and University of Michigan: hair loss due to chemotherapy, or alopecia or disease that caused hair loss.
    • UAW Retiree Medical Benefits Trust: hair loss resulting from any medical condition or treatment.
    Billing Rule

    Complete claim coding and provider identification

    Submit the most specific applicable diagnosis and CPT/HCPCS codes and report the provider National Provider Identifier on every claim.

    • Applicable HCPCS codes include A4452, A4649, and A9282.

    Background

    A wig is an artificial covering of hair for all or most of the head and may be made from synthetic or natural hair. The enhanced benefit addresses hair loss associated with chemotherapy, alopecia, disease, or other medical conditions or treatments, depending on the member’s plan.

    Definitions

    Wig
    DefinitionAn artificial covering of hair for all or most of the head made of either synthetic or natural hair.

    Not Covered

    The following are not covered: wigs, wig stands, and wig-related adhesives under Original Medicare, and items furnished to members whose selected Medicare Plus Blue Group PPO plan does not include the enhanced wig benefit.

    Policy Summary
    PayerBlue Cross Complete of Michigan
    PolicyMedicare Advantage Preferred Provider Organization Enhanced Benefit Policy
    Policy CodePolicy N/A
    Change TypeRevised
    Effective DateJan 1, 2026
    Next Review DateN/A
    Key ActionVerify the member's plan benefit, authorization requirements, cost sharing, and remaining maximum before furnishing a wig.
    SourceLink
    On This Page
    Coverage CriteriaMedical Necessity RequirementsCoding and Benefit ParametersProvider Actions and Billing RisksDocumentation RequirementsBackgroundDefinitionsNot Covered
    No restrictions
  1. A determination should be obtained before furnishing an item when coverage is uncertain.
    2. Documentation Required

    Prescription and Medical Indication Required

    Retain the physician prescription and document the medical indication supporting coverage. Requirements vary by plan: State Health Plan Medicare Advantage PPO and University of Michigan coverage require chemotherapy-related hair loss or alopecia/disease causing hair loss, while the UAW Retiree Medical Benefits Trust requires hair loss resulting from any medical condition or treatment.

    • State Health Plan Medicare Advantage PPO and University of Michigan: physician prescription plus hair loss due to chemotherapy, or alopecia or disease that caused hair loss.
    • UAW Retiree Medical Benefits Trust: physician prescription for hair loss resulting from any medical condition or treatment.
    Billing Rule

    Complete Claim Coding and Provider Identification

    Submit claims using the applicable Medicare Advantage PPO billing requirements and report all applicable CPT/HCPCS and diagnosis codes to the highest level of specificity, along with the provider's National Provider Identifier (NPI).

    • Use the CMS 1500 (02/12), UB-04, or equivalent 837 claim form.
    • Send electronic and paper claims to the applicable local Blue Cross plan.
    Billing Rule

    Verify Benefits, Approved Amount, and Cost Share

    Verify the member's plan benefits and cost sharing before furnishing the item. Confirm the approved amount, applicable member cost share, and any remaining lifetime or annual maximum through the provider portal or by calling 1-866-309-1719.

    • State Health Plan Medicare Advantage PPO: covered up to 100% of the approved amount until the $300 lifetime limit is met.
    • UAW Retiree Medical Benefits Trust: 100% of the approved amount up to a $250 annual maximum.
    • University of Michigan: 100% of the approved amount with no deductible, copay, or coinsurance.
    • The provider is paid the lesser of the maximum allowed amount or the provider's charge, minus applicable member cost sharing.
    Denial Risk

    Confirm the Benefit Is Included in the Member's Plan

    Coverage for wigs, wig stands, and wig-related adhesives is an enhanced benefit available only under select Medicare Plus Blue Group PPO plans. Confirm that the member's plan includes the benefit before providing the item.

    • Original Medicare does not cover wigs; plan-specific benefit terms, reimbursement limits, and cost sharing apply.
    • Do not assume the enhanced benefit is included in every Medicare Plus Blue plan.

    Unsupported block type: denial_risk teeter

    Billing Rule

    Do Not Improperly Bill the Member

    Providers may collect only the appropriate Medicare Plus Blue cost sharing. If a noncovered item is provided without first obtaining a coverage determination, the member must be held harmless for all charges except any applicable cost share.

    • Do not bill the member for the difference between the allowed amount and the provider's charge; the allowed amount less applicable cost sharing is payment in full.
    • A member who voluntarily elects a confirmed noncovered service is responsible for the entire charge.
    • Do not use an Advance Beneficiary Notice of Noncoverage to shift responsibility for a potentially covered item.
  2. Report diagnosis and procedure codes to the highest level of specificity.
  3. Report the provider NPI on all claims.