Braces and supports are used to support a weak or deformed body member or to restrict or eliminate motion in a diseased or injured part of the body. Payment may be made for rigid and semi-rigid braces and supports when prescribed by a physician. Purchase of more than two of the same type of brace or support on the same day is considered not medically necessary.
Completely elastic supports [e.g., athletic supporter, joint supports, trusses, etc.] are not eligible for payment. Supports (L0160, L0180-L0200, L0621, L0622, L0628, L0629, L0630) and trusses with pads (L8300-L8330) are considered semi-rigid, however, and are covered items.
For compression stockings, see Medical Policy Bulletin E-1.
A hernia support which meets the definition of a covered brace, whether in the form of a corset (L0628, L0629) or a truss (L8300-L8330), is eligible for payment when the patient's hernia is reducible. When a corset is prescribed for use as a hernia support, the claim should be processed under procedure code L0628 or L0629.
The Sykes Hernia Control (a spring-type, U-shaped, strapless truss)(L8499) is not more beneficial than a conventional truss. Reimbursement for this device should be based on the allowance for a conventional truss (codes L8300-L8310).
Prosthetic devices which are dispensed to a patient prior to performance of the procedure that will necessitate use of the device are not covered. Dispensing a prosthetic device in this manner would not be considered reasonable and necessary for the treatment of the patient's condition.
Coverage for Prosthetics and Orthotics is determined according to individual or group customer benefits. |