Supportive lumbar orthosis, lumbar-sacral orthosis, and thoracic-lumbar-sacral orthosis are considered experimental and investigational for other indications because their effectiveness for indications other than the ones listed above has not been established.
To support weak spinal muscles and/or a deformed spine.To reduce pain by restricting mobility of the trunk or.To facilitate healing following a surgical procedure on the spine or related soft tissue (see section on Post-operative Back Braces below) or.To facilitate healing following an injury to the spine or related soft tissues or.Lumbar orthosis, lumbar-sacral orthosis, and thoracic-lumbar-sacral orthosisĪetna considers a lumbar orthosis, lumbar-sacral orthosis, and thoracic-lumbar-sacral orthosis medically necessary for any of the following indications:.Licensed by the state in which services are provided (where legally required).Board of Certification/Accreditation (prosthetics, orthotics) (BOC) or.
#Icd 9 to icd 10 look up table orthopedics professional#
The certified professional orthotist or prosthetist must be in good standing with one or more of the following:.(Services may be provided personally by physicians and performed by personnel under their direct supervision as permitted under state laws, as physicians are not licensed as orthotists and/or prosthetists) and The services provided are of the complexity and nature to require being provided by a licensed or certified professional orthotist and/or prosthetist or provided under their direct supervision by a licensed ancillary person as permitted under state laws.(All services provided must be within the applicable scope of practice for the provider in their licensed jurisdiction where the services are provided) and The orthotic or prosthetic services are performed by a duly licensed and/or certified, if applicable, orthotic and/or prosthetic provider.The orthosis or prosthesis is provided within six months of the date of prescription and.The member’s participating physician or licensed health care practitioner has determined that the orthosis or prosthesis will allow the member to perform ADLs based on physical examination of the member and.The orthosis or prosthesis will significantly improve or restore physical functions required for mobility related activities of daily living (MRADL's) and.
Care is prescribed by a physician, nurse practitioner, podiatrist or other health professional who is qualified to prescribe orthotics and/or prosthetics according to State law and.Orthosis (Orthopedic Brace) and/or ProsthesisĪetna considers an orthosis (orthopedic brace) and/or prosthesis medically necessary when:.This Clinical Policy Bulletin addresses orthopedic casts, braces, and splints.Īetna considers the following orthopedic casts, braces and splints medically necessary (unless otherwise stated) for the listed indications when they are used to treat disease or injury: Number: 0009 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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