L0112 commercial payer coverage policies

5 commercial payer policies list L0112. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.

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Commercial payer policies listing L0112

5 policies from 5 payers

Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.

Aetna

Aetna policies listing L0112, with the code’s status in each
Policy	Effective	Status of L0112
Orthopedic Casts, Braces and SplintsPayerPolicy · AETNA-CPB-0009	Mar 15, 2024	Covered

Anthem

Anthem policies listing L0112, with the code’s status in each
Policy	Effective	Status of L0112
Cranial Remodeling Bands and Helmets (Cranial Orthoses)Clinical Guideline · ANTHEM-CG-OR-PR-04	Jan 6, 2026	Covered

Surest (UnitedHealthcare)

Surest (UnitedHealthcare) policies listing L0112, with the code’s status in each
Policy	Effective	Status of L0112
Plagiocephaly and Craniosynostosis TreatmentPayerPolicy · SUREST-POL-SUREST-plagiocephaly-craniosynostosis-treatment	Jan 1, 2026	Covered

UMR (UnitedHealthcare)

UMR (UnitedHealthcare) policies listing L0112, with the code’s status in each
Policy	Effective	Status of L0112
Plagiocephaly and Craniosynostosis TreatmentPayerPolicy · UMR-POL-UMR-plagiocephaly-craniosynostosis-treatment	Jan 1, 2026	Covered

UnitedHealthcare

UnitedHealthcare policies listing L0112, with the code’s status in each
Policy	Effective	Status of L0112
Plagiocephaly and Craniosynostosis TreatmentPayerPolicy · UHC-POL-plagiocephaly-craniosynostosis-treatment	Jan 1, 2026	Covered