Effective September 1, 2026, Texas Medicaid updated benefit criteria for cranial remolding orthoses (CRO), procedure code S1040, in accordance with House Bill 426 from the 89th Texas Legislature.
The updated criteria expand coverage for certain non-synostotic deformational plagiocephaly conditions, including lateral deformational plagiocephaly, brachycephaly, asymmetric brachycephaly, and dolichocephaly. CRO services require prior authorization and must meet applicable eligibility, documentation, and medical necessity requirements.
TMHP has also released a new CRO Provider training through the TMHP Learning Management System (LMS). The training reviews the updated benefit criteria, including eligibility, prior authorization, and reimbursement requirements.
Providers are encouraged to:
- Review the TMHP notice for complete benefit criteria, prior authorization requirements, and documentation guidelines.
- Complete the CRO Provider training available through the TMHP LMS.
Additional Resources
- TMHP Notice: Update to Cranial Remolding Orthosis Benefit Criteria Effective September 1, 2026
- TMHP LMS: Cranial Remolding Orthosis eLearning
- For more information, call the TMHP Contact Center at 800-925-9126.
Action
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
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