Adult Foot Orthotics and Orthopedic Shoes - DME.MU.205.A

Custom-fabricated orthopedic shoes, foot orthotics, and modifications are covered for skeletally mature adults with documented foot pain/impaired mobility and a qualifying condition (e.g., deformity, plantar fasciitis, inflammatory disease, posterior tibial tendon dysfunction, neuropathy/neuromuscular disease, rheumatoid or vascular disease) when prefabricated devices have failed/intolerant/contraindicated; A9283 is covered for foot pressure off‑loading of existing foot ulcers and L3250 for toe/distal partial foot amputation, while devices for pes planus, knee/back pain, or knee/hip osteoarthritis are not covered. Coverage is limited to one pair of custom shoes and two pairs of inserts per calendar year and requires documentation of skeletally mature status, the qualifying diagnosis and prefabricated-device trial failure/intolerance/contraindication, a prescription by a qualified provider, and use of RT/LT HCPCS modifiers.

"Custom-fabricated orthopedic shoes, foot orthotics, and/or modifications/additions are considered medical necessary for an adult (skeletally mature) individual with foot pain and/or impaired mobili..."