Update to Cranial Remolding Orthosis Benefit Criteria Effective Sept. 1, 2026
Date: July 30, 2026
Attention: All Providers
Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 1, 2026, benefit criteria for cranial remolding orthosis (CRO) (procedure code S1040) will be updated in accordance with House Bill 426, 89th Legislature, Regular Session, 2025. Cranial Remolding Orthosis (CRO) is a benefit for CHIP Members as required by Chapter 62, Texas Health & Safety Code, Section 62.1512. The benefit must be in the same amount, duration, and scope as detailed in the TMPPM for Medicaid.
The updated benefit criteria specify that CRO may be a benefit when the client requires CRO as part of the treatment plan for a documented diagnosis of any of the following non-synostotic deformational plagiocephaly conditions:
- Lateral deformational plagiocephaly (LDP)
- Brachycephaly
- Asymmetrical brachycephaly
- Dolichocephaly
Definitions and Descriptions
CRO is defined by the Human Resources Code, Chapter 32, Subchapter B, Section 32.03126 as a custom-fitted or custom-fabricated medical device that is applied to the head to correct a deformity, improve function, or relieve symptoms of a structural cranial disease.
Plagiocephaly refers to an asymmetrical, flattened deformity of the skull and can be used to describe both synostotic and non-synostotic head symmetry.
Craniosynostosis occurs when there is a premature fusion of cranial sutures. Craniosynostosis may cause synostotic plagiocephaly, a flattened deformity of the skull as a result of the premature fusion of cranial sutures.
Non-synostotic deformational plagiocephaly (DP) is head-flattening that results from external forces that mold the skull in the first year of life. The following are categories of DP that may require treatment with a CRO:
- LDP is described as an asymmetric head which occurs when an infant’s skull is flattened on one side. This can be predominantly anterior (forehead flattening) or posterior (occipital flattening). The flattening may be accompanied by anterior displacement of the ear, forehead, and in severe cases, the orbit.
- Brachycephaly describes a short, wide head. The occiput flattens and there may be bilateral widening in the tempo-parietal regions. There may also be bulging noted above the ears.
- Asymmetric brachycephaly is the combination of plagiocephaly and brachycephaly. It is characterized by occipital flattening accompanied by parietal asymmetry. The flattening may be accompanied by anterior displacement of the ear, forehead, and in severe cases, the orbit.
- Dolichocephaly is characterized by flattening on both sides of the head and elongation from anterior to posterior.
Conservative therapy for treatment of non-synostotic plagiocephaly involves non-surgical, proactive methods to reshape the infant’s skull, primarily through consistent repositioning, increased tummy time, and physical therapy to treat underlying torticollis. These methods are most effective when started early (before 4–6 months of age) to alleviate pressure on the flat spot.
Claims Reimbursement
Claims for procedure code S1040 may be reimbursed for patients who are 3 months through 18 months of age and have been diagnosed with one of the following:
- Synostotic plagiocephaly as a result of craniosynostosis
- Non-synostotic plagiocephaly that meets diagnostic criteria
CRO will be limited to one device per lifetime, by any provider. This limitation may be exceeded with prior authorization for fee for service (FFS) patients.
Orthotist providers may be reimbursed for procedure code S1040 for services rendered in the home setting.
Additional Information:
Update to Cranial Remolding Orthosis Benefit Criteria Effective September 1, 2026
Next step for providers: Providers should share this information with their staff.
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts