Orthotic Devices and Shoes - (0543)

Cigna covers medically necessary orthotic devices and shoes — including specified cranial orthoses, upper/lower limb orthoses, AFO/KAFO, knee braces, spinal orthoses, therapeutic/custom foot orthoses and diabetic shoes — but excludes protective helmets, prophylactic/athletic or convenience devices, pressure‑ulcer off‑loading items, many add‑ons, and devices deemed experimental/investigational (e.g., MyoPro, electronic stance‑control KAFOs, SpineCor, powered exoskeletons). Coverage requires a prescription and a documented physical exam within 12 months plus device‑ and condition‑specific documentation (functional assessment, trials of conservative/prefabricated options when required, ambulatory status for AFO/KAFO, cranial asymmetry or prior surgery for cranial orthoses, ROM and therapy plan for night splints, radiographic proof for unicompartmental knee offloading, and justification for custom fabrication or replacement).

"General: An orthotic device is considered medically necessary when BOTH of the following criteria are met: - The orthosis is prescribed to support, align, prevent or correct a deformity. - Evidence..."