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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules state that a spinal orthosis (L0450 - L0651) is covered when it is ordered for one of the following 
indications:  
1. To reduce pain by restricting mobility of the trunk; or  
2. To facilitate healing following an injury to the spine or related soft tissues; or  
3. To facilitate healing following a surgical procedure on the spine or related soft tissue; or  
4. To otherwise support weak spinal muscles and/or a deformed spine.  
If a spinal orthosis is provided and the coverage criteria are not met, the item will be denied as not medically 
necessary. You can find this rule at Local Coverage Determination (LCD): Spinal Orthoses: TLSO and LSO 
(L33790). 
 
Per Medicare references listed below the rules state: ?Section 424.57(c)(12) requires suppliers, as part of their 
standards to be met for enrollment and participation, to maintain proof of delivery documentation in their files. 
In certain instances, compliance with proof of delivery may be required as a condition of payment, and must be 
available to the DME MAC, RAC, SMRC, CERT, and ZPIC/UPIC on request. For such items, if the supplier 
does not have appropriate proof of delivery documentation within the prescribed timeframes, associated claims 
will be denied and overpayments recouped. We note that non-compliance with supplier standards may also 
result in revocation from the Medicare program. Suppliers who consistently do not provide documentation to 
support their services may be referred to the OIG or NSC for investigation and/or imposition of sanctions. If 
the beneficiary is newly eligible to the Medicare program, the proof of delivery standards require the supplier 
to obtain a statement, signed and dated by the beneficiary (or beneficiary's designee), that the supplier has 
examined the item. 
 
Also, ?Any person who can sign and accept the delivery of durable medical equipment on behalf of the 
beneficiary.? Suppliers, their employees, or anyone else having a financial interest in the delivery of the item 
are prohibited from signing and accepting an item on behalf of a beneficiary (i.e., acting as a designee on 
behalf of the beneficiary). The signature of the designee should be legible. If the signature of the designee is 
not legible, the supplier/shipping service should note the name of the designee on the delivery slip. Three 
methods of delivery are: Supplier delivering directly to the beneficiary or designee; Supplier utilizing a 
delivery/shipping service to deliver items; and Delivery of items to a nursing facility on behalf of the 
beneficiary. ?The date of delivery may be entered by the beneficiary, designee or the supplier. As a general 
Medicare rule, the date of service shall be the date of delivery. Exceptions are made for suppliers who use a 
delivery/shipping service. If the supplier uses a delivery/shipping service, the supplier may use the shipping 
date as the date of service on the claim. The shipping date may be defined as the date the delivery/shipping 
service label is created or the date the item is retrieved for delivery; however, such dates should not 
demonstrate significant variation. (See Pub. 100-08, chapter 5, section 5.2.4 for further information on written 
orders prior to delivery. You can find these guidelines in the Medicare Program Integrity Manual, Chapter 5 - 
Items and Services Having Special DME Review Considerations, Section 5.8 - Supplier Documentation; 
Medicare Program Integrity Manual Chapter 4 - Program Integrity, Section 4.26 - Supplier Proof of Delivery 
Documentation Requirements, Subsection 4.26.1 - Proof of Delivery and Delivery Methods. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.