Documentation Needs for Cranial Orthosis for Plagiocephaly

The Blue Cross Blue Shield of North Dakota (BCBSND) Utilization Management team is informing the provider community of the documentation requirements for Cranial Orthosis for Plagiocephaly which applies to our BCBSND Commercial line of business only. Documentation is needed when submitting a claim for this type of Durable Medical Equipment (DME) service.
Documentation requirements for Cranial Orthosis for Plagiocephaly
To determine the medical necessity of the request for Cranial Orthosis, the following documentation must be provided at the time of the request.
Medical records to include documentation of all the following:

  • Include the measurements to determine the severity of the problem.
  • Include clinical documentation of any type of conservative treatment that has been attempted: such as repositioning for at least two months.
  • Use support tables within the policy for reference on what is used for this claim review. 

For additional information review our Cranial Orthosis for Plagiocephaly | BCBSND policy.