Medicare AdvantageDocumentationMedium impact
Spinal Orthoses
Independence Blue Cross·PA · Orthopedics, PM&R (Physical Medicine & Rehab), Neurosurgery +1 more·Medical Policy
Effective date
Aug 18, 2026
We identified it
Jun 16, 2026
Summary
Face-to-Face encounter requirements have been removed for spinal orthoses codes L0457 and L4000, and new CG modifier requirements have been added for specific LSO/TLSO codes when made of nonelastic material or having rigid posterior panels. The policy becomes effective August 18, 2026.
Action Required
By August 18, 2026: Billing team must update billing system to remove face-to-face encounter requirements for codes L0457 and L4000. Add CG modifier requirement for codes L0450, L0454, L0455, L0621, L0625, and L0628 when orthoses are made primarily of nonelastic material or have rigid posterior panels. Update encounter forms and documentation templates to reflect these modifier requirements.