2.2 Orthoses are devices, such as braces or
splints, that are applied externally to the body to support, align,
prevent or correct deformities, improve the function of movable
parts of the body, or restrict or eliminate motion in a diseased
or injured part of the body. These items modify the functional and
structural characteristics of the neuromuscular and musculoskeletal
systems.
2.2.1 There
are specific HCPCS codes that identify orthoses. Examples of orthoses
include but are not limited to:
• Spinal (thoracic,
cervical, lumbar, sacral);
• Lower limb (hip,
knee, ankle-foot, knee-foot-ankle, and hip-knee-ankle-foot, plus
the orthopedic shoe(s) that are an integral part of the brace);
• Upper limb (shoulder,
elbow, wrist-hand-finger);
• Splints for
extremities;
• Braces for leg, arm, neck, back and shoulder.
2.2.2 A
custom fabricated orthosis brace is one that is individually made
for a specific patient. No other patient would be able to use the
brace. A custom brace is based on clinically derived and rectified castings,
tracings, measurements, and/or other images (such as X- rays) of
the body part. The fabrication may involve using calculations, templates,
and components. This process requires the use of basic materials
including, but not limited to, plastic, metal, leather, or cloth
in the form of uncut or unshaped sheets, bars, or other basic forms
and involves substantial work such as vacuum forming, cutting, bending,
molding, sewing, drilling and finishing prior to fitting on the
patient.
2.2.3 A custom fitted orthosis brace is one that
is prefabricated and that requires fitting and adjustment. For example,
the brace must be trimmed, bent, molded (with or without heat),
or otherwise modified for a specific patient to provide an individualized
fit. Modifications must result in alterations to the brace beyond
simple adjustments made by bending, trimming, and/or molding, installation
of add-on components, or assembly.
Note: An orthosis
leg brace involving the foot extends above the ankle and is made
of metal or other durable rigid material that immobilizes, restricts
movement in a given direction, controls mobility, assists with movement,
reduces weight-bearing forces or holds body parts in correct position.