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Insurance Reimbursement for Anke Foot Orthosis (AFO)

AFO ankle foot orthosis fitting orthotist elevate drop foot

Key Takeaways

Are you curious on how insurance reimbursement works with Ankle Foot Orthotic Devices or AFOs? Whether you were recently diagnosed with foot drop, you currently wear an AFO, or you have a custom thermoplastic AFO and want a carbon fiber AFO, this article is for you!

  • AFOs (braces) are a prescribed medical orthotic device that are used to treat drop foot, a lower leg weakness where the foot and ankle have difficulty with dorsiflexion and plantarflexion. 
  • Doctors prescribe AFOs and work with orthotists to submit to insurance companies a detailed prescription based on their evaluation of your gait pattern. 
  • If you need a new AFO, check with your insurance provider and then schedule an appointment with your orthotist who will be able to walk through some options.

This is My First AFO, Will My Insurance Cover It?

Once a physician prescribes you an AFO, most times, you are then referred to a clinician, called an orthotist, where you will be evaluated and assessed for the appropriate ankle foot orthosis depending on your diagnosis. Your orthotist will work with your insurance company to justify and get approval of the AFO (brace). Once approved, your device is determined to be medically necessary and you can be fit with the product.

How Often Can I Get a New AFO?

If you need a new AFO, the best thing to do is to check with your insurance provider on their coverage for renewing braces. All insurances are different, but Medicare will typically provide coverage for renewing braces every 3-5 years based on medical need.

However, if you are currently struggling with your device and want to learn more, we suggest scheduling an appointment and talking to your orthotist who will be able to help walk you through some alternative options. 

Will My Insurance Cover Elevate's FreeFlow, Glide or HelixBand?

Elevate products are all verified by HCPCS codes, a standardized code set necessary for Medicare and other health insurers to provide healthcare claims. When an orthotist fits you with a brace, they use these codes to show insurance companies the specific product they used and will potentially get reimbursed for. 

Please see below for specific HCPCS codes for Elevate products:

  • FreeFlow: L-1951
  • Glide: L-1932
  • HelixBand: L-2270

What Are AFOs?

Ankle foot orthoses are a prescribed medical device. 

There are many different types of AFOs, but they typically all consist of a footplate covering the heel to the forefoot, a strut (potentially with an ankle joint), and a calf piece. They can be made with carbon fiber or thermoplastic.

Diagnoses That May Cause You To Need an AFO

Different diagnoses that may cause you to need an AFO consist of, but are not limited to, the following: 

Injuries

  • Nerve injury (peroneal nerve)
  • Traumatic brain injury
  • Spinal Cord Injury

Neuromuscular diagnoses

  • Multiple Sclerosis
  • Cerebral Palsy
  • CMT
  • Stroke (CVA)

Every diagnosis is different, however AFOs can make a huge difference by dynamically supporting muscle weakness in the lower limb to help optimize a patient’s gait (walking) pattern.

Discover what you can do with Elevate.

Elevate’s products are designed alongside clinicians and patients to enable a healthier life through movement.

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