Latest Review Date: June 2023

Category: Orthotic/Physical Therapy/ Chiropractor Services    

POLICY:

KEY POINTS:

Some degree of scoliosis is frequent in the general population, although few patients have curves that require treatment.  There is no reliable method for predicting at initial evaluation, which curves will progress; thus observation is the primary treatment of all curves.

The COPES Scoliosis Treatment Recovery System is the invention of Arthur L. Copes, Orthotist, Ph.D., founder of the Copes Foundation.  This foundation was a for-profit organization dedicated to the detection and treatment of idiopathic scoliosis. No published, peer-reviewed studies were found to demonstrate the effectiveness of this therapy in the treatment of scoliosis.

The Copes Scoliosis Brace is a custom-fitted polypropene support structure that utilizes air to attain spinal curvature correction. This is achieved through the use of strategically placed pneumatic force vector pads that are adjusted every 4 to 6 weeks during treatment. The brace is generally used for 12 to 36 months in conjunction with hydrotherapy, regular muscle strengthening exercises, as well as chiropractic treatments such as osseous manipulation and muscle stimulation therapy. There is no scientific evidence that the Copes Scoliosis Brace is effective in treating scoliosis. Additionally, there are no published data concerning the long-term effectiveness of this device, the rate of recurrence of scoliosis after patients stop wearing the brace or the number of patients who eventually have to undergo surgical intervention. Furthermore, the Copes Scoliosis Brace is used in conjunction with hydrotherapy, regular muscle strengthening exercises and chiropractic treatments. Thus, it is unclear what role the brace actually plays in the improvement, if any, of the condition.

KEY WORDS:

STRS, Scoliosis Dynamic Brace, COPES Scoliosis Brace

Approved by Governing Bodies:

Not applicable

BENEFIT APPLICATION:

Coverage is subject to member’s specific benefits.  Group-specific policy will supersede this policy when applicable.

ITS: Home Policy provisions apply

FEP: Special benefit consideration may apply.  Refer to member’s benefit plan.

CURRENT CODING:

CPT Codes:

HCPCS:

REFERENCES:

1. Behrman R.E., Kliegman R.M., Jenson H.B. Nelson Textbook of Pediatrics, 16th Edition Mosby, 2000.

2. Canale S.T., Campbell’s Operative Orthopaedics, 9th Edition. Mosby, 1998.

3. IOM (Institute of Medicine). 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press

4. Scoliosis.  Supplemental treatments, www.netspace.org/~dbilbao/scoliosis/supptreat.html

5. Taft E, and Francis R. Evaluation and management of scoliosis, J Pediatr Health Care 2003 Jan-Feb; 17(1): 42-44.

POLICY HISTORY:

Medical Review Committee, February 1998

Medical Policy Group, September 2001

Medical Policy Administration Committee, October 2001

Medical Policy Group, January 2003

Medical Policy Group, February 2004

Medical Policy Group, February 2006 (1)

Medical Policy Group, February 2007 (1)

Medical Policy Group, February 2008 (1)

Medical Policy Group, February 2009 (1): Active Policy but no longer scheduled for regular literature reviews and updates effective February 13, 2009.

Medical Policy Group, December 2012 (3): 2013 Coding Updates: Code 97530-removed “by the provider’

Medical Policy Group, October 2013 (1) Removed ICD-9 Diagnosis/Procedure codes; no change to policy statement.

Medical Policy Group, May 2019 (7): There is no new published peer-reviewed literature available that would alter the coverage statement in this policy.

Medical Policy Group, June 2021 (7): Reviewed by consensus. There is no new published peer-reviewed literature available that would alter the coverage statement in this policy.

Medical Policy Group, June 2022 (7): Reviewed by consensus. There is no new published peer-reviewed literature available that would alter the coverage statement in this policy.

Medical Policy Group, June 2023 (7): Reviewed by consensus. Update to Benefit Application and References. There is no new published peer-reviewed literature available that would alter the coverage statement in this policy.

This medical policy is not an authorization, certification, explanation of benefits, or a contract. Eligibility and benefits are determined on a case-by-case basis according to the terms of the member’s plan in effect as of the date services are rendered. All medical policies are based on (i) research of current medical literature and (ii) review of common medical practices in the treatment and diagnosis of disease as of the date hereof. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels of care and treatment.

This policy is intended to be used for adjudication of claims (including pre-admission certification, pre-determinations, and pre-procedure review) in Blue Cross and Blue Shield’s administration of plan contracts.

The plan does not approve or deny procedures, services, testing, or equipment for our members. Our decisions concern coverage only. The decision of whether or not to have a certain test, treatment or procedure is one made between the physician and his/her patient. The plan administers benefits based on the member’s contract and corporate medical policies. Physicians should always exercise their best medical judgment in providing the care they feel is most appropriate for their patients. Needed care should not be delayed or refused because of a coverage determination.

As a general rule, benefits are payable under health plans only in cases of medical necessity and only if services or supplies are not investigational, provided the customer group contracts have such coverage.

The following Association Technology Evaluation Criteria must be met for a service/supply to be considered for coverage:

1. The technology must have final approval from the appropriate government regulatory bodies;

2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes;

3. The technology must improve the net health outcome;

4. The technology must be as beneficial as any established alternatives;

5. The improvement must be attainable outside the investigational setting.

Medical Necessity means that health care services (e.g., procedures, treatments, supplies, devices, equipment, facilities or drugs) that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease or its symptoms, and that are:

1. In accordance with generally accepted standards of medical practice; and

2. Clinically appropriate in terms of type, frequency, extent, site and duration and considered effective for the    

    patient’s illness, injury or disease; and

3. Not primarily for the convenience of the patient, physician or other health care provider; and

4. Not more costly than an alternative service or sequence of services at least as likely to produce equivalent     

      therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.