LCDActive
Spinal Orthoses: TLSO and LSO
L33790
Noridian Healthcare Solutions, LLC (J19)
Effective: January 1, 2020
Updated: December 31, 2025
Policy Summary
Medicare covers spinal orthoses (specific HCPCS codes listed) when they are reasonable and necessary, meet Medicare benefit category requirements, and are ordered to reduce trunk mobility-related pain, facilitate healing after spine injury or surgery, or support weak/deformed spinal structures. Coverage is contingent on meeting documentation and coding rules (SWO/WOPD, proof of delivery, HCPCS coding and LCD-related documentation); failure to meet these criteria results in claim denial.
Coverage Criteria Preview
Key requirements from the full policy
"Spinal orthoses (listed HCPCS codes) are covered when ordered to reduce pain by restricting mobility of the trunk."
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