As expected, the height requirement for an AFO is being removed by medicare.
Let’s get on with helping people walk!
Below is the text from the Medicare website:
February 6, 2013
Ankle-Foot Orthoses/Knee-Ankle-Foot Orthoses LCD related Policy Article – Revised
The related Policy Article for the Ankle-Foot Orthosis/Knee-Ankle-Foot Orthosis is being revised. The Policy Article with an effective date of January 1, 2013 included Coding Guidelines for AFOs that included a height requirement. The height requirement is being removed. The effective date for the revised Policy Article is for dates of service on or after January 1, 2013.
See for yourself here:
http://www.cgsmedicare.com/jc/pubs/news/2013/0213/cope21209.html
Again, the only type of AFO that requires a PDAC Coding verification letter is the L1906. Insightful does not use that code for any of its current bracing. To verify this for yourself, please see the PDAC website listing those that are required. The link to this page is below.
https://www.dmepdac.com/review/items_requiring_coding_verification_reviews.html
Finally, keep in mind that the pretibial shell that has been offered by our competitors is essentially a custom shin guard, the argument that this provides axially unloading as medical justification is risky in our opinion.
AFO Blog 