Are Back Braces Covered By Medicare?

This is a question I get asked a lot from Medicare patients that are interested in getting a back brace or support, and the simple answer is yes! Medicare does cover back braces and other medical equipment and supplies them deem medical necessary under Durable Medical Equipment coverage. Read that last sentence over again especially the part about “medical necessary“. In order to get Medicare to pay for your back brace it must be medical necessary so what does medical necessary mean? Well according to Medicare the definition of medical necessary is as follows

““medically necessary” is defined as “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” In any of those circumstances, if your condition produces debilitating symptoms or side effects, then it is also considered medically necessary to treat those.”

Right about now you might be thinking well I’ve been suffering from back pain for years so a back brace is definitely medical necessary and Medicare should have no problem covering it, well you may be right but in Medicares eye’s you will need documentation. And in order to get this documentation your doctor must be aware of your back pain and there must be documentation of  an injury or medical condition that is causing your pain. If your doctor is unaware of your back pain, or if there is no history of back pain in your medical records Medicare will deny your claim.

Steps To Take In order To Get Your Back Brace Covered

In order to get your back brace covered by Medicare follow these steps

1. Speak to your doctor about about your back pain if your doctor believes a back brace will help reduce your pain they will sign a prescription for you.
2. Contact a licensed and accredited Medicare DME provider  (*If a DME provider is not accredited they will not be able to bill Medicare for your back brace.)
3. Receive your back brace and sign required paperwork.

Does Medicare Pay The Entire Cost?

No, Medicare covers 80% of the cost associated with getting a back brace. This means that you are responsible for the remaining 20% unless you have  a secondary insurance in which case your secondary would cover the 20%. For example suppose your doctor wrote you a prescription for a L0650 back brace and Medicare’s reimbursement rate (amount a provider will receive from Medicare for providing medical service or equipment) is $750 Medicare would pay $600 and you or the secondary insurance would have to pay the remaining $150.00.

Conclusion 

I hope this article helped to answer your questions regarding Medicare’s coverage of back braces but if you still have any questions please comment below or you can email me directly at info@csamedicalsupply.com