![]() ![]() ![]() Board of Certification/Accreditation (prosthetics, orthotics) (BOC) or.American Board for Certification (orthotics, prosthetics, pedorthics) (ABC) or.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 rovided 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.Scoliosis braces and castsĪetna considers an orthosis (orthopedic brace) and/or prosthesis medically necessary when: Please note this includes the MAGEC System but does not apply to other expandable magnetic growing rods (e.g., Phenix Growing Rod device) which are considered investigational and experimental. Idiopathic scoliosis with curve greater than or equal to 50 degrees in a young adult age 18 to 25.Īetna considers growing rods technique medically necessary in the treatment of idiopathic scoliosis for persons who meet criteria for surgery above.Idiopathic scoliosis with curve greater than or equal to 40 degrees in an adolescent younger than age 18 or.Aetna considers surgery (e.g., spinal fusion with instrumentation and bone grafting) for the treatment of idiopathic scoliosis medically necessary for any of the following conditions:.Aetna considers surface electrical muscle stimulators (direct or alternating current, not high-voltage galvanic current) experimental and investigational for the management of idiopathic scoliosis because there is inadequate evidence of its effectiveness and safety in the peer-reviewed published medical literature.This Clinical Policy Bulletin addresses idiopathic scoliosis. Number: 0398 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References ![]()
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