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IMS Experts Partnership with HCA
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Indications for Medical Necessity

Pt requires brace:
⃝     To provide stabilization to weak or injured wrists
⃝     To prevent wrist flexion, extension, rotation, and deviation
⃝     To provide treatment of carpal tunnel syndrome, tendinitis or Rheumatoid arthritis
⃝     Post-surgical treatment of wrist and thumb
⃝     Post cast healing or soft tissue injury


Clinical Note Requirements: Dictation must be exactly as shown above for the indication chosen.

Wrist Brace Indications for Prescribed PT:

(Must select one of the following):

Wrist Brace




Most common ICD-10 codes:

G56.00 - Carpal tunnel syndrome
M06.9 - Rheumatoid arthritis 
M84.339K - Radius with ulna
S62.109A - Closed, carpal bone, unspecified Wrist NOS
S62.90XK - Malunion and nonunion of fracture 
S62.90XP - Malunion of fracture


Wrist Document Requirements: Signed/Dated RX, Clinicals with Indications. Up to date patient demographics with insurance information.

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