CG-DME-22 Ankle-Foot & Knee-Ankle-Foot Orthoses

This policy addresses coverage for ankle-foot orthoses (AFOs) and knee-ankle-foot orthoses (KAFOs). Coverage is medically necessary for ambulatory individuals (with or without assistance) who have foot/ankle weakness or deformity requiring stabilization and a reasonable expectation of functional benefit; KAFOs are covered when an AFO is appropriate but additional knee stability is needed, and custom-fabricated devices are covered when criteria are met and the person cannot be fit with a prefabricated device or the condition is permanent/longstanding (>6 months). Not covered if criteria are not met or when used solely for edema, prevention/treatment of heel pressure ulcers, fixed contractures, or isolated foot drop without an ankle flexion contracture.

"An ankle-foot orthosis (AFO) is consideredmedically necessaryfor ambulatory (i."

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