Orthopedic Casts, Braces and Splints

Aetna covers orthoses/prostheses only when prescribed by a qualified provider, shown by physical exam to significantly improve or restore mobility-related ADLs, furnished within six months and provided by a licensed/certified orthotist/prosthetist (ABC/BOC or state-licensed) at the appropriate level of professional complexity. Lumbar/lumbosacral/TLSO braces are covered for spine injury or post‑surgical healing, pain control by trunk restriction, or to support weak/deformed spines; custom-fitted/fabricated back braces are covered only after failure/contraindication/intolerance to prefabricated (or custom‑fitted) braces or as the initial brace after surgical stabilization for traumatic injury, while other indications (many post‑op uses, supportive lumbar braces for nonlisted indications, and certain knee/adjustable joint braces outside recent injury/surgery within 6 weeks) are considered experimental/investigational and not covered (and some post‑op braces may be included in the surgical protocol with no separate coverage).