Spinal Orthoses: TLSO and LSO

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.

"Spinal orthoses (listed HCPCS codes) are covered when ordered to reduce pain by restricting mobility of the trunk."

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