Gait Analysis

This policy covers comprehensive, laboratory‑based gait analysis (including 2‑ or 3‑dimensional kinematic assessment with videotaped/optoelectronic marker systems and dynamic EMG) to inform surgical planning and clinical assessment in patients with gait disorders—primarily children with cerebral palsy—and other neurologic or orthopedic impairments (e.g., clubfoot, stroke, spinal cord injury, aging, orthotic/prosthetic planning). Coverage is limited to comprehensive tests performed in a dedicated lab by specialized staff with demonstrated clinical validity and utility; non‑comprehensive analyses, inertial measurement systems/Outwalk protocols, and use for surgical planning, postoperative evaluation, or rehabilitation planning outside of cerebral palsy are considered experimental, investigational, or unproven.

"Comprehensive gait analysis for surgical planning in individuals with gait disorders associated with cerebral palsy."