![]() To support weak spinal muscles and/or a deformed spine.To reduce pain by restricting mobility of the trunk or.To facilitate healing following a surgical procedure on the spine or related soft tissue (see section on Post-operative Back Braces below) or.To facilitate healing following an injury to the spine or related soft tissues or.Lumbar orthosis, lumbar-sacral orthosis, and thoracic-lumbar-sacral orthosisĪetna considers a lumbar orthosis, lumbar-sacral orthosis, and thoracic-lumbar-sacral orthosis medically necessary for any of the following indications:.Licensed by the state in which services are provided (where legally required).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 provided 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. ![]()
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