All PlansCoverageMedium impact
Interventions for Progressive Scoliosis
Blue Cross & Blue Shield of Mississippi·MS · Orthopedics, Pediatrics·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a new medical policy establishing coverage criteria for interventions treating progressive scoliosis, including orthotic bracing and fusionless surgical procedures like vertebral body stapling and tethering. The policy defines specific criteria for high-risk patients (curves 25°-40° with 2+ years growth remaining) and excludes coverage for patients not at high-risk or those requiring conventional fusion surgery (45°+ curves).
Action Required
Immediately: Review current scoliosis treatment protocols to ensure compliance with new coverage criteria. Billing team must verify that orthotic bracing and fusionless surgical procedure claims meet the policy requirements: patients aged 10+ with juvenile/adolescent idiopathic scoliosis, Cobb angles 25°-40°, Risser grade 0-2, and at least 2 years growth remaining. Update prior authorization requests to include required clinical documentation (Cobb angle measurements, Risser sign, age, growth assessment). Claims not meeting these specific criteria may be denied.