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Interventions for Progressive Scoliosis
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
A rigid cervical-thoracic-lumbar-sacral or thoracic-lumbar-sacral orthosis (brace) may be considered medically necessary for scoliosis in juvenile and adolescent individuals at high risk of progression who meet the listed criteria. Vertebral body stapling and vertebral body tethering for scoliosis are considered investigational. The most recent update dated 10/14/2026 updated the policy description regarding vertebral body tethering and updated the first medically necessary policy statement for clarity.
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What to do
Action · 4 steps
01Check current applicability: confirm the current version at the source link before billing these services, because this material is historical (source dated 2025-05-06).
02Billing team: for brace claims (CTLSO codes L1000 to L1120 and TLSO codes L1200 to L1290), confirm documentation supports the criteria: an idiopathic spinal curve angle between 25 and 40 degrees with spinal growth not completed (Risser grade 0 to 3, and no more than 1 year post-menarche in females), or an idiopathic curve angle greater than 20 degrees with a documented increase in the curve angle and at least 2 years of growth remaining (Risser grade 0 or 1, or pre-menarche in females).
03Use of an orthosis that does not meet these criteria is investigational.
04Billing team: treat CPT 22836, 22837, 22838, 22899, 0656T, 0657T and 0790T as investigational, since vertebral body stapling and vertebral body tethering for scoliosis are considered investigational.
Codes mentioned
22836228372283822899L1000L1120L1200L1290M41.112M41.129
Original notice
Interventions for Progressive Scoliosis
bcbsms.com · Always check the source before changing claims.
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