Knee Braces

This policy addresses coverage of knee braces—primarily prefabricated (off‑the‑shelf) braces for knee instability, symptomatic medial‑compartment osteoarthritis (including unloader braces), and rehabilitation—with custom‑fabricated braces considered only when abnormal limb contour, deformity, or size precludes off‑the‑shelf use despite documented attempts to fit. It applies to patients with knee instability from injury, painful medial‑compartment osteoarthritis, and post‑operative/rehabilitation needs, and includes an Illinois‑specific provision for children with certain neuromuscular/cognitive disorders, while prophylactic and most sport‑specific custom braces are not covered. Coverage is subject to the member’s benefit plan and state rules, and this medical policy is inactive and not to be used for current claims adjudication.

"For Illinois only: coverage of therapy, diagnostic testing, and equipment necessary to increase quality of life for children clinically or genetically diagnosed with a disease, syndrome, or disorde..."