UPDATE: T.E.N.S. & Anthem BC/BS
FDA-approved T.E.N.S. units are considered medically necessary when prescribed as a treatment for pain for those who have not responded to other modalities, and the pain is related to a musculoskeletal condition or the pain associated with an active or post-trauma injury.
FDA-approved T.E.N.S. garments are considered medically necessary when there is a large area or many sites to be stimulated such that use of conventional electrodes, adhesive tapes, and lead wires is not feasible, the areas or sites to be stimulated are inaccessible with the use of conventional electrodes, adhesive tapes, and lead wires, or there is a documented medical condition, such as skin problems, that preclude the application of conventional electrodes, adhesive tapes, and lead wires.
UPDATE: Lumbar Braces & Aetna
Aetna considers a lumbar orthosis, lumbar-sacral orthosis, and thoracic-lumbarsacral orthosis medically necessary to facilitate healing following an injury to the spine or related soft tissues , to facilitate healing following a surgical procedure on the spine or related soft tissue, to reduce pain by restricting mobility of the trunk, or to support weak spinal muscles and/or a deformed spine.
Supportive lumbar orthosis, lumbar-sacral orthosis, and thoracic-lumbar-sacral orthosis are considered experimental and investigational for other indications because their effectiveness for indications other than the ones listed above has not been established. Following a strain/sprain, supportive lumbar orthosis, lumbarsacral orthosis, and thoracic-lumbar-sacral orthosis (back supports, lumbo-sacral supports, support vests) are used to render support to an injured site of the back. The main effect is to support the injured muscle and reduce discomfort.
UPDATE: Knee Braces & Cigna
A prefabricated functional knee brace (i.e. off-the-shelf, custom-fitted) is considered medically necessary when there is documented knee instability and the individual is not considered a surgical candidate for ligament reconstruction.
A custom-fabricated functional knee brace is considered medically necessary when the criteria for a prefabricated functional knee brace have been met and the individual is unable to be fitted with a prefabricated device as a result of an abnormal limb contour (e.g. disproportionate size/shape), knee deformity (e.g. valgus, varus deformity), or minimal muscle mass upon which to suspend the orthosis.
For more info on products mentioned in this article or for info on current product specials, please contact your personal MeyerPT Account Manager.
If you don’t know who your Account Manager is, please call 866.528.2144 to find out.