|Highmark Medical Policy Bulletin|
|Section:||Orthotic & Prosthetic Devices|
|Topic:||Foot Orthotics for Conditions Other Than Diabetes|
|Effective Date:||January 1, 2002|
|Issued Date:||January 1, 2002|
|Date Last Reviewed:|
General Policy Guidelines
Orthotics serve to protect or restore/improve function of moveable parts of the body with orthopedic appliances or apparatus which support, align, or prevent/correct deformities. Foot orthotics are ordered by a physician and fabricated to meet specific needs of the patient and may or may not include the shoe and any modifications and/or transfers necessary to make the orthotic functional and effective. Therefore, when a benefit, foot orthotics which meet the above definition are covered when prescribed for the following conditions:
Achilles tendonitis (726.71)
(Foot orthotics prescribed for non-surgically treated fractures are not routinely eligible for reimbursement. Payment will be made only if supporting documentation satisfactorily establishes the orthotic's medical necessity in the case at hand.)
However, foot care products which can be purchased over-the-counter without a prescription, e.g., premolded arch supports, (L3040-L3090), do not meet the definition of foot orthotics and are not covered.
Orthotic shoes are eligible only when they are an integral part of a brace (L3224 and L3225) and when prescribed by a physician for an eligible condition as listed above. Orthotic shoes not an integral part of a brace, (L3201-L3223, L3230, and L3251-L3255) are noncovered.
Modifications (L3000-L3030, and L3300-L3595) and transfers (L3600-L3640) to foot orthotics are eligible, whether or not the foot orthotic is an integral part of a brace, when the diagnosis reported is one for which foot orthotics are eligible. Procedure codes L3100-L3170 and L3257- L3265 represent other foot orthotic services, e.g. abduction/adduction devices, and are eligible when reported with an eligible diagnosis/condition.
For information on orthotic footwear for diabetic patients, see Medical Policy E-15, Diabetic Services and Supplies.
For information on the prosthetic shoe (L3250), see Medical Policy O-2, Prosthetic Shoe.
Traditional (UCR/Fee Schedule) Guidelines
Managed Care (HMO/POS) Guidelines
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Procedure Code Attachment