Lower Limb Orthoses – Coverage Criteria and Physician Documentation Requirements

A letter from Stacey V. Brennan, M.D., FAAFP Medical Director, DME MAC, Jurisdiction B to physicians.

Dear Physician,

Leg braces are covered by Medicare when they are required to support the limb and/or restrict or eliminate motion of a joint because of disease, injury, congenital condition, or orthopedic surgical procedure. Although elastic supports may be beneficial to treat certain conditions, they are not eligible for coverage under the Medicare statutory brace benefit. Also, brace-like items that are used solely for pressure reduction and/or wound healing—e.g., devices used for the treatment of foot ulcers—are not eligible for coverage under the brace benefit.  To view and download the rest of this letter, please click on the following link  LOWER LIMB ORTHOSES