Orthotic Devices and Shoes - Cigna

Page 1 of 58 Medical Coverage Policy: 0543 Medical Coverage Policy Effective Date .. 7/15/2021 Next Review Date .. 8/15/2022 Coverage Policy Number .. 0543 Orthotic Devices and Shoes Table of Contents Overview .. 1 Coverage Policy .. 2 General Background .. 8 Medicare Coverage Determinations .. 20 Coding/Billing Information .. 21 References .. 47 Related Coverage Resources Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds Foot Care Services Lumbar Fusion for Spinal Instability and Degenerative Disc Conditions, including Sacroiliac Fusion Minimally Invasive Spine Surgery Procedures and Trigger Point Injections Percutaneous Vertebroplasty, Kyphoplasty and Sacroplasty Physical Therapy Plantar Fasciitis Treatments Prosthetic Devices Stretch Devices for Joint Stiffness and Contracture Subtalar Arthroereisis INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies.

I. Cranial Orthosis Coding for Cranial Orthoses • A custom molded/fitted cranial orthotic device (HCPCS code S1040) is considered medically necessary for the treatment of synostotic plagiocephaly (i.e., craniosynostosis) following surgical correction when the benefit plan includes coverage for this indication.

Tags:

  Shooter, Cranial, Cranial orthoses

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