Question 1

What is HCPCS code S1040?

Accepted Answer

HCPCS code S1040 is "Cranial remolding orthosis". Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)

Question 2

What category is S1040 in?

Accepted Answer

S1040 belongs to HCPCS Category S (Temporary National Codes (Non-Medicare)).

Question 3

When should I use HCPCS code S1040?

Accepted Answer

Use S1040 when billing for cranial remolding orthosis. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is S1040 covered by Medicare?

Accepted Answer

Coverage for S1040 (Cranial remolding orthosis) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for S1040?

Accepted Answer

Documentation for S1040 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).