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COPES Scoliosis Treatment Recovery System

Policy Number: MP-019

Latest Review Date: May 2019

Category:  Orthotic/Physical Therapy/ Chiropractor Services    

Policy Grade: Active Policy but no longer scheduled for regular literature reviews and updates.

DESCRIPTION OF PROCEDURE OR SERVICE:

The COPES Scoliosis Treatment Recovery System (STRS) incorporates several treatments into its plan of care, addressing five distinct areas:

  1. Osseous
    • Bone changes

    • Growth problems

  2. Biomechanical

    • Increase in ligamentous flexibility

    • Curve structure deformities

    • Decrease and increase in ROM

  3. Neurological

    • Ocular

    • Vestibular

    • Proprioception

    • Central Nervous System

    • Upper Motor Neuron  deformities

    • Somatical sensory

  4. Muscular

    • Imbalance origins and interactions

    • A & B fibers

    • Scarring of the myotendon area

  5. Endocrinology

    • Trace Elements

    • Nutritional deficits

    • Hormonal imbalances

    • Digestive

    • Genetics

The following services are included in the COPES Scoliosis Treatment Recovery System:

  • Dynamic, Air-injected Bracing

    • The COPES Scoliosis Dynamic Brace is custom-cast, custom-fitted, and custom-fabricated to the exact body dimensions of each patient
    • The COPES Scoliosis Dynamic Brace works in two distinct ways; it de-weights the spine to relieve gravitational pressure and supports the body in a symmetrical environment so the pneumatic force vector units (PFVU) can apply a spectrum of pressure to straighten and de-rotate the vertebral bodies and rib structure
    • Injections of air into the PFVUs are performed every six weeks.  This technique was borrowed from the orthodontic community that adjusts teeth braces monthly; therefore, slowly correcting dental misalignment
  • A Three-Phase Exercise Plan

    • Phase 1: 13 distinct exercises designed to regain patient’s normal range of motion

    • Phase 2: 12 distinct exercises designed to increase patient’s strength

    • Phase 3: Body-building exercises designed to increase patient’s overall system strength

  • Scoliosis Muscle Stimulation Therapy

    • Eight or more sites of stimulation are identified and a treatment protocol is established through x-ray analysis and Surface Electromyography (EMG) studies

  • Chiropractic Mobilization Therapy

    • Intersegmental adjustments and flexion distraction

  • Ocular Vestibular Therapy

    • The STRS therapy includes cross-crawl training in conjunction with cervical traction that applies pressure while the patient is wearing the brace.  This therapy is administered 1 to 3 times per week, extending throughout the duration of treatment.

  • Nutritional Therapy

    • Nutrition and diet are an integral part of the STRS.

  • Hydrotherapy

    • Consists of a daily 20-minute soak in hot water to which two tablespoons of baking soda are added.  In the last five minutes of hydrotherapy, a full capful of Alpha-Keri™ is added.

POLICY:

COPES Scoliosis Treatment Recovery System (which includes the COPES Dynamic brace, ocular vestibular therapy, nutritional therapy, hydrotherapy and EMG) is considered not medically necessary and investigational for the treatment of scoliosis.

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 contracts: FEP does not consider investigational if FDA approved and will be reviewed for medical necessity. Special benefit consideration may apply.  Refer to member’s benefit plan.

CURRENT CODING:

CPT Codes:

95860

Needle electromyography, one extremity with or without related paraspinal areas 

95861

Needle electromyography, two extremities with or without related paraspinal areas

95863

Needle electromyography, three extremities with or without related paraspinal areas

95864

Needle electromyography, four extremities with or without related paraspinal areas

95869

Needle electromyography; thoracic paraspinal muscles  

97014

Application of a modality to one or more areas; electrical stimulation (unattended)

97022

Application of a modality to one or more areas; whirlpool

97032

Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes

97110

Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

97112

Therapeutic procedure, one or more areas; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception 

97530

Therapeutic activities, direct (one-to-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes

98940

Chiropractic manipulative treatment (CMT); spinal, one to two regions

98941

             ; spinal, three to four regions

98942 

             ; spinal, five regions

98943

             ; extraspinal, one or more regions

 

HCPCS:

L1499

Spinal orthosis not otherwise specified

L1300

Other scoliosis procedure, body jacket molded to patient model

        

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

  4. Taft E, and Francis R.  Practice Guidelines:  Evaluation and management of scoliosis, J Pediatr Health Care 2003; 17(1): 42-4

  5. www.scoliosis.com COPES Scoliosis Treatment Recovery System.

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.

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.