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Issue Number - Name
0024 - Complex Comprehensive Spinal Orthosis Delivery
Review Type
Complex
Claim Type
DME by supplier, DME by physician
Region and State
RAC 5
All States
Date Approved
2017-08-02

Description

Medical necessity and coding review: Documentation will be reviewed to determine if Spinal Orthoses meet Medicare coverage criteria.

Affected Codes

  • HCPCS codes: L0450, L0452, L0454, L0455, L0456, L0457, L0458, L0460, L0462, L0464, L0466, L0467, L0468, L0469, L0470, L0472, L0480, L0482, L0484, L0486, L0488, L0490, L0491, L0492, L0621, L0623, L0625, L0626, L0627, L0628, L0629, L0630, L0631, L0632, L0633, L0634, L0635, L0636, L0637, L0638, L0639, L0640, L0641, L0642, L0643, L0648, L0649, L0650, L0651

Applicable Policy References

  • Social Security Act, Section 1833(e)
  • Social Security Act, Section 1834(a)
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Sections 4.26, 4.26.1
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Sections 5.2, 5.7, and 5.8
  • 42 Code of Federal Regulations, Section 405.980 (b) and (c)
  • 42 Code of Federal Regulations, Section 405.986
  • CGS Administrators LCD, L11448, Effective 10/1/1993, Retired 9/30/2015
  • CGS Local Coverage Article, A24086, Effective date 1/1/2005, Retired 9/30/2015
  • CGS Administrators LCD, L33790, Effective date 10/01/2015
  • CGS Local Coverage Article, A52500, Effective date 10/01/2015