backs supports

WE ARE A CMS (MEDICARE) CONTRACTED BID WINNER FOR

OTS BACK BRACES

For patients struggling with chronic pain and muscle weakness, a daily routine can be a constant struggle. Thankfully, bracing technology has improved dramatically over the years, allowing patients with a wide variety of conditions to maintain their quality of life. Conditions which can benefit from bracing range from muscle weakness and lower back pain to disc degeneration and spinal disorders, as well as post-operative patients who are simply in need of additional support during their recovery period.

We offer a variety of braces from industry leading manufacturers, individually selected by your doctor or other qualified medical professional to meet each patient’s specific needs. We utilize braces with a lightweight, modular design which allows for easy, on the spot adjustments, and a level of comfort previously unimaginable to many of our newly-relieved patients.

In addition to our popular back brace products, we also provide our patients with a wide array of knee, ankle, and wrist braces. As with our back braces, these products are tailored to a patient’s specific needs as determined by consulting with their doctor.

We work with Medicare as well as some private insurers such as Blue Cross Blue Shield. Our experienced bracing specialists will work with you and your doctor to find the right products for your specific needs and conditions. Additionally, our representative will work with your insurance to minimize – and in many cases, eliminate altogether – the out-of-pocket cost to the patient for the supplies they need to maintain their quality of life. If you or a loved one is suffering from conditions that may benefit from bracing solutions, do not hesitate, and call 704-821-7777.

Our Most Popular Back Supports

Horizon™ Lumbar

#993710

PDAC Code L0627 Approved

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With a lowest profile design within the line, the Horizon™ 627 Lumbar provides essential trunk stability and targeted compression by utilizing the widely-praised SlickTrack™ tightening system. One size adjustable, the Horizon 627 Lumbar comfortably fits waist sizes ranging from 24-50 inches, and up to 70 inches with the extension panels. To further support patient recovery, the Horizon braces can be stepped down to the Horizon PRO for treatment of recurring ailments.

Size Chart

  • Adjustable 24in (61cm) – 50in (127cm)

Horizon™ LSO

#993730

PDAC Code L0648 Approved

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The Horizon™ 637 LSO provides trunk stability and targeted compression designed to support fatigued muscles causing secondary back pain resulting from surgery or injury. Moveable, rigid side panels provide lateral support and a comfortable environment for healing. One size adjustable, the Horizon 637 LSO comfortably fits waist sizes ranging from 24-50 inches, and up to 70 inches with the extension panels. To further support patient recovery, Horizon braces can be stepped down to the Horizon PRO for treatment of recurring ailments.

Size Chart

  • Adjustable 24in (61cm) – 50in (127cm)

Horizon™ TLSO

#993740

PDAC Code L0457 Approved

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The Horizon™ 637 LSO provides trunk stability and targeted compression designed to support fatigued muscles causing secondary back pain resulting from surgery or injury. Moveable, rigid side panels provide lateral support and a comfortable environment for healing. One size adjustable, the Horizon 637 LSO comfortably fits waist sizes ranging from 24-50 inches, and up to 70 inches with the extension panels. To further support patient recovery, Horizon braces can be stepped down to the Horizon PRO for treatment of recurring ailments.

Size Chart

  • Adjustable 24in (61cm) – 50in (127cm)

You may benefit from a back support brace if you have any of the following indications:

  • Acute and Chronic low back pain

  • Lumbar muscle weakness.

  • Low back sprains and strains

  • Mechanical or discogenic lumbar pain

  • Prophylactic low back support

  • Post-operative lumbar stabilization

  • Degenerative disc disease

  • Spinal blocks

  • Post-operative lumbar fusion stabilization

  • Spondylolysis

  • Spinal stenosis

  • Spondylolisthesis

  • Laminectomy

  • Discectomy

  • Facet syndrome

Coverage Indications, Limitations, and/or Medical Necessity
 

For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements.

The purpose of a Local Coverage Determination (LCD) is to provide information regarding “reasonable and necessary” criteria based on Social Security Act § 1862(a)(1)(A) provisions.

In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement:

  • The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section.

  • The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section.

  • Refer to the Supplier Manual for additional information on documentation requirements.

  • Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD.


For the items addressed in this LCD, the "reasonable and necessary" criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity.

For spinal orthoses definitions of Off-The-Shelf (OTS), custom fitted and custom fabricated, refer to the CODING GUIDELINES section in the LCD-related Policy Article.

A spinal orthosis (L0450, L0452, L0454, L0455, L0456, L0457, L0458, L0460, L0462, L0464, L0466, L0467, L0468, L0469, L0470, L0472, L0480, L0482, L0484, L0486, L0488, L0490, L0491, L0492, L0621, L0622, L0623, L0624, L0625, L0626, L0627, L0628, L0629, L0630, L0631, L0632, L0633, L0634, L0635, L0636, L0637, L0638, L0639, L0640, L0641, L0642, L0643, L0648, L0649, L0650, L0651) is covered when it is ordered for one of the following indications:

  1. To reduce pain by restricting mobility of the trunk; or
     

  2. To facilitate healing following an injury to the spine or related soft tissues; or
     

  3. To facilitate healing following a surgical procedure on the spine or related soft tissue; or
     

  4. To otherwise support weak spinal muscles and/or a deformed spine.

If a spinal orthosis is provided and the coverage criteria are not met, the item will be denied as not medically necessary.

GENERAL

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted. If the supplier bills for an item addressed in this policy without first receiving a completed SWO, the claim shall be denied as not reasonable and necessary.

For Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) base items that require a Written Order Prior to Delivery (WOPD), the supplier must have received a signed SWO before the DMEPOS item is delivered to a beneficiary. If a supplier delivers a DMEPOS item without first receiving a WOPD, the claim shall be denied as not reasonable and necessary. Refer to the LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section.

For DMEPOS base items that require a WOPD, and also require separately billed associated options, accessories, and/or supplies, the supplier must have received a WOPD which lists the base item and which may list all the associated options, accessories, and/or supplies that are separately billed prior to the delivery of the items. In this scenario, if the supplier separately bills for associated options, accessories, and/or supplies without first receiving a completed and signed WOPD of the base item prior to delivery, the claim(s) shall be denied as not reasonable and necessary.

An item/service is correctly coded when it meets all the coding guidelines listed in CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, or DME MAC articles. Claims that do not meet coding guidelines shall be denied as not reasonable and necessary/incorrectly coded.

Proof of delivery (POD) is a Supplier Standard and DMEPOS suppliers are required to maintain POD documentation in their files. Proof of delivery documentation must be made available to the Medicare contractor upon request. All services that do not have appropriate proof of delivery from the supplier shall be denied as not reasonable and necessary.

If you need any support on measuring or sizing options, please contact one of our Mobility Consultants.

Call 704-821-7777, or feel free to stop by our showroom at 251 N Trade St. Matthews, NC 28105