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TLSO/LSO Coverage Guidelines

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A spinal orthosis is covered when it is ordered for one of the following indications:

  1. To reduce pain by restricting mobility of the trunk; or

  2. To facilitate healing following an injury to the spine or related soft tissues; or

  3. To facilitate healing following a surgical procedure on the spine or related soft tissue; or

  4. To otherwise support weak spinal muscles and/or a deformed spine.

If a spinal orthosis is provided and the coverage criteria are not met, the item will be denied as not medically necessary.

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