Note on Diabetic Shoe Benefit: Medically necessary foot orthotics may be covered for diabetic members of Aetna HMO plans with a diabetic shoe benefit, and for diabetic members of traditional plans without an exclusion for orthopedic shoes and supportive devices for the feet. licensed by the state in which services are provided (where legally required).Board of Certification/Accreditation (prosthetics, orthotics) (BOC) or.American Board for Certification (orthotics, prosthetics, pedorthics) (ABC) or.The certified professional orthotist or prosthetist must be in good standing with one or more of the following:.(Services may be provided personally by physicians and performed by personnel under their direct supervision as permitted under state laws, as physicians are not licensed as orthotists and/or prosthetists) and The services provided are of the complexity and nature to require being provided by a licensed or certified professional orthotist and/or prosthetist or provided under their direct supervision by a licensed ancillary person as permitted under state laws.(All services provided must be within the applicable scope of practice for the provider in their licensed jurisdiction where the services are provided) and The orthotic or prosthetic services are performed by a duly licensed and/or certified, if applicable, orthotic and/or prosthetic provider.The orthosis or prosthesis is provided within six months of the date of prescription and.The member’s participating physician or licensed health care practitioner has determined that the orthosis or prosthesis will allow the member to perform ADLs based on physical examination of the member and.
See 'Policy Limitations and Exclusions' for additional information. This Clinical Policy Bulletin addresses foot orthotics.Īetna considers orthosis (foot orthotics) and/or prosthesis medically necessary (unless otherwise specified) for the following indications when criteria are met. Number: 0451 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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