Ankle-Foot/Knee-Ankle-Foot Orthosis
L33686
AFOs and KAFOs are covered when they are Medicare benefit-category eligible, reasonable and necessary, and meet specific clinical criteria: nonambulatory positioning AFOs (L4396/L4397) are covered for plantar-flexion contracture with passive dorsiflexion >=10° and accompanying therapy or for plantar fasciitis; ambulatory AFOs/KAFOs are covered for ambulatory beneficiaries with foot/ankle weakness or deformity who require stabilization and can benefit functionally. Custom-fabricated devices require inability to fit prefabricated options or other specific clinical conditions (e.g., permanent condition >6 months, multi-plane control, tissue-injury risk, or abnormal healing fracture), replacement interfaces are allowed only when initial coverage continues and are limited to one per 6 months, and multiple coding, documentation (SWO/WOPD, goniometer ROM, stretching program, POD), and coding-guideline requirements must be met or claims will be denied.
"An item is covered only if it is in a Medicare benefit category, is reasonable and necessary for diagnosis/treatment or to improve functioning of a malformed body member, and meets all other Medica..."