New Documentation Requirements for Thoracic Lumbar Sacral Orthoses

Posted by on Aug 15, 2013 in General |

CMS Now Requires ‘Doc’-umentation For TLSOs as Well


First lower-limb prostheses, now spinal braces. We have been advised that effective Jan. 1, 2013 the CMS physician documentation standards for justifying medical necessity of lower-extremity prosthetic limbs adopted in 2011 have been extended to thoracic lumbar sacral orthoses (TLSOs). That means that to qualify for Medicare reimbursement, all TLSO prescriptions must be supported by detailed notations in the physician’s chart establishing need for the device.

Documentation in the beneficiary’s physician medical record must show the orthosis was ordered for one of the following indications:

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  • reduce pain by restricting mobility of the trunk;
  • facilitate healing following an injury to the spine or related soft tissues;
  • facilitate healing following a surgical procedure on the spine or related soft tissue; or
  • otherwise support weak spinal muscles and/or a deformed spine.

As with prosthetic patients, we are ready to partner with our referring physicians to provide whatever clinical and product information is necessary to establish medical necessity in the patient’s record for the spinal orthosis ordered.

Please call the Alltech O & P offices at 888-897-3231 if you have any questions.