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Prior Authorization

Cranial Remolding Orthosis

All requests for Cranial Remolding Orthosis (CRO) must be medically necessary and require prior authorization.

Documentation Requirements for Prior Authorization Requests:

  • Prescription
  • Medical Records – including diagnosis, history of treatment, assessment of severity and any other documentation supporting the request.
  • Prior Authorization Request Form

Submit completed form to:

  • Department of Social Services
    Division of Medical Services
    EPSDT Coordinator
    700 Governors Drive
    Pierre, SD 57501
  • Phone: 605-773-3495
  • Fax: 605-773-5246