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 Healthcare Common Procedure Coding System (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.