Orthopedic Footwear - Policy Article

Orthopedic footwear and related inserts/modifications are covered only when the shoe is an integral part of a covered brace and are medically necessary for the proper functioning of that brace; specific HCPCS codes (e.g., L3224/L3225, L3649, L3250 and many insert/modification codes) and conditions (e.g., diabetic therapeutic shoes under a separate policy) determine coverage. Claims must comply with modifier rules (KX for items integral to braces, GY if not), include RT/LT, meet Final Rule 1713 face‑to‑face and WOPD requirements where applicable, and follow documentation rules (including supplier billing and narrative/diagnosis specificity) or they will be denied as noncovered or not reasonable and necessary.

"Shoes, inserts, and modifications are covered when the shoe is an integral part of a covered leg brace described by HCPCS L1900, L1920, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2050, L2060..."