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L0112 |
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Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated
| short | Cranial cervical orthosis |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L0113 |
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Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment
| short | Cranial cervical torticollis |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L0120 |
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Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)
| short | Cerv flex n/adj foam pre ots |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L0130 |
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Cervical, flexible, thermoplastic collar, molded to patient
| short | Flex thermoplastic collar mo |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L0140 |
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Cervical, semi-rigid, adjustable (plastic collar)
| short | Cervical semi-rigid adjustab |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L0150 |
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Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)
| short | Cerv semi-rig adj molded chn |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L0160 |
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Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf
| short | Cerv sr wire occ/man pre ots |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L0170 |
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Cervical, collar, molded to patient model
| short | Cervical collar molded to pt |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L0172 |
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Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf
| short | Cerv col sr foam 2pc pre ots |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L0174 |
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Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf
| short | Cerv sr 2pc thor ext pre ots |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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