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Date Printed: October 23, 2017: 02:13 AM

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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

Subject: Orthotics

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This medical coverage guideline is not an authorization, certification, explanation of benefits, or a guarantee of payment, nor does it substitute for or constitute medical advice. All medical decisions are solely the responsibility of the patient and physician. Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. This medical coverage guideline applies to all lines of business unless otherwise noted in the program exceptions section.

 

DESCRIPTION

Orthotics are devices that support, restore or protect a function of your body. Orthotics may also redirect or restrict the motion of an impaired body part. Types of orthotics include supports, braces and splints and can be rigid or semi-rigid.

Visit the Clinical View of this guideline for more information.

Visit WebMD for more information on orthotics.

COVERAGE

 

Note: For all medical decisions about this service, Florida Blue uses the Position Statement in the Clinical View of this medical coverage guideline. To make the best decision for your health needs, talk to your doctor. The services covered vary from health plan to health plan. Refer to your health plan contract for complete information about your coverage.

 

The following orthotic devices and orthotic-related services meet the definition of medical necessity:

• Appliances necessary for effectively using artificial limbs or corrective braces

• Braces for the leg, arm, neck, back or shoulder

• Corsets for the back or for use after special surgical procedures

• Harnesses necessary for using artificial limbs

• Hernia devices

• Space shoes

• Splints for extremities

• Therapeutic shoes for treating diabetic disease (depth or custom-molded, including inserts or modifications)

• Trusses

• Additions or modifications to an orthotic device when ordered by your doctor.

• Replacement of an orthotic device when your doctor documents the need due to a change in your condition, or the orthotic device is damaged or worn beyond repair.

• Custom molded and designed shoe inserts or supportive devices for the feet when certain requirements are met.

These items are not orthotic devices or are excluded:

• Arch supports or shoe inserts designed to effect conformational changes in the foot or foot alignment

• Cast shoes

• Orthopedic shoes, unless integrated into a leg brace

• Over-the-counter, custom-made or built-up shoes

• Ready-made compression hose

• Self-purchased splints and trusses

• Sneakers

• Support hose.

Visit the Clinical View of this guideline for specific coverage information.

PROGRAM EXCEPTIONS

• Federal Employee Program (FEP): Certain exceptions apply.

• State Account Organization (SAO): Certain exceptions apply.

• Medicare Advantage products: Certain exceptions apply.

Visit the Clinical View of this guideline for more coverage information.

Refer to your health plan contract for complete information about your coverage.

Date Printed: October 23, 2017: 02:13 AM