Spinal Orthoses: TLSO and LSO - Policy Article

Medicare covers LSO and TLSO spinal orthoses under the braces benefit when the device is rigid or semi-rigid and the treating practitioner and LCD support medical necessity. Coding, documentation, and statutory payment rules must be met: prefabricated vs custom classification depends on the level of adjustment at final fitting (42 CFR §414.402), face-to-face and WOPD requirements apply for specified HCPCS under Final Rule 1713, and certain nonrigid or fabric garments (e.g., A4467, L0984) are noncovered; CAD/CAM, fitting, and fabrication services are included in the orthosis allowance.

"Lumbar-sacral orthoses (LSO) and thoracic-lumbar-sacral orthoses (TLSO) are covered under the Medicare braces benefit when the device is rigid or semi-rigid and is used to support a weak or deforme..."

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