The Impact of California Assembly Bill 2668: Expanding Coverage for Cranial Prostheses

How California Assembly Bill 2668 Will Improve Access to Cranial Prostheses for Patients Facing Medical Hair Loss

Medical hair loss can be a deeply emotional and stressful experience for many individuals. Whether due to chemotherapy, autoimmune conditions like alopecia, or other medical treatments and diseases, the loss of hair often leads to psychological distress, affecting both mental health and social interactions. For these patients, medical wigs, also known as cranial prostheses, provide more than just a cosmetic solution—they offer a means to regain confidence and improve quality of life.

The California Legislature has recognized the critical need to support patients facing medical hair loss by introducing Assembly Bill 2668 (AB 2668). This groundbreaking legislation will require state-regulated health plans to provide coverage for cranial prostheses for individuals experiencing temporary or permanent hair loss due to medical conditions or treatments. Let’s dive into what this bill means for healthcare providers, insurers, and—most importantly—patients.

What Does AB 2668 Cover?

Effective January 2025, AB 2668 mandates that state-regulated health insurance plans cover cranial prostheses (medical wigs) for patients who suffer hair loss due to:

• Alopecia Areata: An autoimmune disorder that causes patches of hair loss.
• Chemotherapy-Induced Hair Loss: Hair loss as a result of cancer treatment.
• Lupus: An autoimmune disease that can cause severe hair thinning or loss.
• Scarring Alopecia: Permanent hair loss due to burns, infections, or autoimmune disorders.
• Other Medical Conditions: Any medically diagnosed condition that leads to hair loss.

Under AB 2668, health plans will be required to cover up to $750 per medical wig each year. This cap ensures that patients have access to a cranial prosthesis annually without bearing the full financial burden out of pocket. However, any cost above the $750 limit, as well as standard cost-sharing (e.g., deductibles and co-pays), will remain the patient's responsibility.

Who Benefits from AB 2668?

California Assembly Bill 2668 applies to 24.2 million Californians who are enrolled in state-regulated insurance plans, including Medi-Cal beneficiaries, CalPERS enrollees, and individuals covered under commercial insurance. These enrollees will now have access to cranial prostheses if they experience hair loss due to medical treatments or conditions.

Prior to AB 2668, only about 29% of enrollees had access to insurance coverage for cranial prostheses, with many patients forced to pay out-of-pocket for medical wigs, which can range from $450 to $5,000 depending on the quality, style, and materials used. After the bill's enactment, 100% of state-regulated plans will be required to provide coverage, significantly expanding access to medical wigs across the state.

How Does This Impact Healthcare Providers?

For healthcare providers, AB 2668 offers an opportunity to support patients struggling with hair loss by guiding them through the process of obtaining a cranial prosthesis through their insurance. Here’s what providers need to know:

1.Documenting Medical Necessity:  Providers (such as dermatologists, oncologists, or other specialists) will need to prescribe a cranial prosthesis as part of the patient’s treatment plan. This prescription must demonstrate that the wig is medically necessary, enhancing the patient’s well-being, mental health, and social confidence.

2. Billing Process for Cranial Prostheses: Although cranial prostheses don't have a specific CPT code, providers will likely bill using HCPCS codes related to Durable Medical Equipment (DME) or prosthetics. A frequently used code could be L8499 (Unlisted prosthetic service), but each insurer might have different requirements for billing these prostheses.

• Providers should ensure that they include all relevant documentation, including the diagnosis code (ICD-10) associated with the medical condition causing hair loss. For example:

• L63.0: Alopecia Areata.
• C50.911: Chemotherapy-induced hair loss for breast cancer.
• M32.0: Lupus leading to hair loss.

• It's crucial to confirm with the patient’s insurance plan whether prior authorization is required to avoid denials and ensure a smooth claims process.

3. Claim Submission and Cost-sharing:

• Once all documentation is prepared, the provider will submit the claim for the cranial prosthesis. Insurers will reimburse up to $750 for the wig, but any additional costs above this limit will be the patient's responsibility.
• If the claim is denied, providers should assist the patient in requesting a Appeal and, if necessary, follow up with an second level appeal to resolve disputes.

Addressing Disparities in Access to Medical Wigs

While AB 2668 offers significant strides in making cranial prostheses more accessible, challenges remain, particularly in addressing disparities. For example, Black women, who experience higher rates of alopecia and other hair loss conditions, often find it difficult to access wigs that match their hair texture or style through insurance-covered options. The bill’s implementation should ensure that insurers provide a range of medical wigs that cater to diverse patient needs, helping to close this gap.

The passage of AB 2668 is expected to have both financial and public health impacts:

• Financial Impact: The bill is projected to increase annual healthcare expenditures by $26.5 million, which translates to a 0.02% increase. For individual enrollees, the premium increase is estimated to be minimal, ranging from $0.004 to $0.10 per member per month depending on the plan.
• Public Health Benefits: Cranial prostheses play a significant role in improving the mental health and quality of life of patients experiencing medical hair loss. By expanding access to medical wigs, the bill is expected to reduce psychological distress, improve self-esteem, and enhance social well-being for thousands of Californians.

Conclusion: The Path Forward

California Assembly Bill 2668 represents a significant step forward in healthcare equity and mental health support for individuals facing medical hair loss. While the financial impact is modest, the benefits in terms of quality of life improvements are profound. For healthcare providers, the bill offers an opportunity to assist patients with medically necessary cranial prostheses and navigate the insurance process. As this legislation goes into effect in 2025, healthcare providers, insurers, and patients alike will need to stay informed on best practices for accessing and billing for these crucial medical devices.

At Medrina Technology Management, we believe that healthcare should be holistic and patient-centered, addressing both physical and emotional well-being. AB 2668 aligns with our mission to support healthcare providers in delivering compassionate, high-quality care. By staying informed on changes like this, we can continue to help patients lead healthier, more confident lives.