HNS Policy 

 

Revised 01/04/19

 

HNS understands the value of orthotics in the treatment of our patients and want to ensure our documentation supports the medical necessity for the orthotics billed to payors.

 

In an effort to ensure providers have a clear understanding of when it is appropriate to bill for custom foot orthotics - to ANY HNS contracted payor, HNS has modified its Orthotic Policies. 

 

HNS Foot Orthotics Policy

 

Custom foot orthotics should only be billed to a contracted payor when ALL of the following criteria has been met:

 

The chief complaint/objective clinical findings, and diagnosis documented in the healthcare record must clearly support the need for orthotics; and

 

There must be an appropriate treatment plan, which includes orthotics, and which clearly links the need for the orthotics with the goals of the treatment plan; and

 

There must be clear clinical documentation which explains WHY non-custom orthotics would not be appropriate for the condition or diagnosis.

 

The clinical record provides evidence the foot orthotics have been customized from a mold or scan of the patient's foot.

 

The custom foot orthotics are medically necessary to support or aid in the treatment of an illness or injury, as described below:

 

  1. When there is a primary diagnosis of foot pain or a primary diagnosis of a foot condition (e.g. plantar fasciitis, pes planus, pes cavus, etc.) provided that:

    1. Documented objective clinical findings clearly link the prescription of custom foot orthotics to the primary diagnosis and/or chief complaint;

       

      AND

       

    2. The prescription of custom foot orthotics is consistent with the goals of the treatment plan.

       

  2. In the absence of a primary diagnosis of foot pain or a foot condition, custom foot orthotics may be medically necessary when provided concurrent with Chiropractic Manipulative Therapy, provided:

    1. Documented objective clinical findings clearly link the prescription of custom foot orthotics to the primary diagnosis and/or chief complaint;

       

      AND

       

    2. The prescription of custom foot orthotics is consistent with the goals of the treatment plan.

 

 

Replacement of Custom Foot Orthotics

Medically necessary replacement of custom foot orthotics is generally provided under the following conditions: 

  • Following malfunction of the device; or

  • After the device's normal life span, provided there are objective clinical findings clearly linking the replacement of custom foot orthotics to the patient's current primary diagnosis and/or chief complaint; or

  • For growth adjustments, provided there are objective clinical findings clearly linking the replacement of custom foot orthotics to the patient's current primary diagnosis and/or chief complaint. 

 

 

CIGNA Healthcare - Orthotics  

CIGNA Healthcare contracts with a DME Vendor to provide medically necessary orthotics to members. If your CIGNA patient needs orthotics, please contact the CIGNA DME Vendor. (See CIGNA Orthotic Vendor under the CIGNA Healthcare Guide, which can be found under the heading "Billing / Claim Support".) 

  

 

Non-Covered Services Waiver for Orthotics 

HNS has created a new non-covered services waiver specific to custom foot orthotics.

 

If there is ANY doubt the prescription
of orthotics is not consistent with ALL of these policies,
please have your patient sign this waiver.

 

(The waiver is available in Microsoft Word under the HNS Forms section of the website.)