Pediatric Foot Orthotics and Orthopedic Shoes - DME.MU.114.A

Pediatric foot orthotics and orthopedic shoes are covered only for patients under 18 who have documented foot/ankle deformity, abnormal foot/ankle range of motion, foot/ankle weakness, cerebral palsy with abnormal gait, or juvenile arthritis, and are not covered outside these listed circumstances. Coverage requires documentation of the patient's age (<18) and one or more of the listed conditions, and claims must use only the HCPCS codes specified in the policy.

"A foot or ankle deformity"

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