How To Order SpinalQ

1. Letter Of Medical Necessity or Prescription / Script:  

Download form
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:  

1. To reduce pain by restricting mobility of the trunk.
2. To facilitate healing following an injury to the spine or related soft tissues.
3. To facilitate healing following a surgical procedure on the spine or related soft  tissue. 
4. To otherwise support weak spinal muscles and/or a deformed spine. 

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.