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Medical Policy Update: Thoracic-Lumbo-Sacral Orthosis with Pneumatics

Effective January 15, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider claims for thoracic-lumbo-sacral orthoses (TLSO) with pneumatics when provided to Horizon BCBSNJ Medicare Advantage (MA) plan members.

The guidelines of our medical policy, Thoracic-Lumbo-Sacral Orthosis with Pneumatics, identify when a TLSO with pneumatics is considered medically necessary and when it is considered investigational.

We encourage you to review this policy in our Medical Policy Manual.


Based on the guidelines of our medical policy, Thoracic-Lumbo-Sacral Orthosis with Pneumatics, CPT® code E0830 included on claims for services provided on and after January 15, 2018 to patients enrolled in Horizon BCBSNJ MA plans will be denied as an experimental/investigational service regardless of the submitted diagnosis code(s).

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after January 15, 2018.

CPT® is a registered mark of the American Medical Association.

Published on: December 15, 2017, 10:09 a.m. ET
Last updated on: December 15, 2017, 10:10 a.m. ET