CG-DME-20 Orthopedic Footwear

This policy addresses orthopedic footwear (shoes, inserts, and shoe modifications), including prosthetic shoes. Coverage is limited to items that are integral to a medically necessary leg brace (including heel/sole replacements and shoe transfers for the braced shoe), inserts/modifications needed for proper brace function, or prosthetic shoes that are integral to a prosthesis for individuals with partial foot amputation. Orthopedic footwear not meeting these criteria—including standalone shoes/inserts/modifications, a matching non-braced shoe and related items, or shoes worn over a partial foot or other lower extremity prosthesis attached by other means—is not covered.

"Shoes, inserts, and modifications are consideredmedically necessaryonly in the limited circumstances described below:"

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