1. Letter Of Medical Necessity or Prescription / Script:
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Please include height, weight, chest measurement or bra size.
2. Demographics / Face Sheet:
Patient's address, phone number, and date of birth.
3. Insurance Card:
Copy of the front and back of insurance card.
4. Medical Chart Notes / Progress Notes From The Doctor:
The progress notes need to support the prescription for the SpinalQ TLSO Brace. They should include one of the following below:
A thoracic-lumbar-sacral orthosis (L0450-L0492) is covered when it is ordered for one of the following indications:
5. RFA :
Work comp only.
Click HERE for a free no obligation insurance verification to determine if your insurance will cover the SpinalQ brace, if so follow the steps above once you hear from our insurance specialist.
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