A rigid cervical-thoracic-lumbar-sacral or thoracic-lumbar-sacral orthosis may be considered medically necessary for the treatment of scoliosis in juvenile and adolescent patients at high risk of progression that meets the following criteria:
Idiopathic spinal curve angle between 25° and 40°; AND
Spinal growth has not been completed (Risser grade 0-3; no more than 1 year after menarche in females)
Idiopathic spinal curve angle greater than 20°; AND
There is a documented increase in the curve angle; AND
At least 2 years of growth remain (Risser grade 0 or 1; premenarche in females).
Use of an orthosis for the treatment of scoliosis that does not meet the criteria above is considered investigational.
Vertebral body stapling and vertebral body tethering for the treatment of scoliosis are considered investigational.