## **What is the HCPCS code S1040 for?**
The HCPCS code S1040 designates a custom-fabricated cranial remolding orthosis for infants and young children. This cranial remolding is rigid and is made with soft interface material. The service comes with fitting and adjustment.
A cranial remolding orthosis is a kind of cranial orthotic device normally given to infants or young children with irregular head shapes or positional skull deformation as part of cranial molding orthosis therapy. Healthcare professionals begin by assessing abnormal head shapes, and when deemed necessary, they will recommend that the child wear a cranial shaping helmet (also known as a cranial molding helmet).
Conditions like the following may result in irregular head shapes in children:
- Birth trauma
- Positional plagiocephaly (typically consists of right or left occipital flattening)
- Brachycephaly
- Scaphocephaly
- Prolonged supine sleeping as part of sudden infant death syndrome (SIDS) prevention practices, which can sometimes lead to positional skull flattening
Infants aged 3 to 18 months are at risk of having cranial deformities or cervical anomalies because these are the months when their heads are most malleable. However, it is best started at 3 to 6 months old.
## **Documentation requirements for S1040**
Before filing a claim for S1040, please make sure you have sufficient documentation:
- The full name of the infant/young child who will wear the orthosis
- The full names and credentials of the healthcare professionals handling the child
- Medical records showing the diagnosis of the problem that caused the irregular shape of the child's head
- Records of failed conservative therapy (e.g., repositioning therapy, physical therapy) and objective anthropometric measurements (e.g., cranial vault asymmetry index, cephalic index, etc.) confirming moderate to severe deformity of the skull
## **Billing requirements for S1040**
Besides the documentation above, please make sure to have the following:
- An indication that the orthosis is custom-fabricated, includes fitting, and allows for periodic adjustments
- Manufacturer's invoice dated within six months of service with specific details like the patient's name, helmet cost, the manufacturer's information, invoice number/date, item ID, DME provider information.
Please ensure you follow CMS guidelines/provider coding policies; otherwise, your claim will be denied outright.
## **Other similar codes**
- **L1836** - Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf
- **L3919** - Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
- **L3702** - Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
- **L3762** - Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf
- **L3935** - Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment
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