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27.2.2 Orthoses
The following orthoses may be reimbursed:
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Orthoses
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Covered Diagnosis and Condition
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Ankle-foot orthoses (AFO), plastic or metal
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Foot anomalies, cerebral palsy, hemiplegia, spina bifida, club foot, arthrogryposis, and arthropathy associated with extremity conditions
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Dynamic splints
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Traumatic brain injury (TBI), cerebral palsy, paraplegia, late effects of cerebrovascular accident (CVA), spinal cord lesions, or other diagnosis resulting in contracture of the upper or lower extremity.
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Foot orthoses
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Foot anomalies, tibial torsion, club foot, varus deformities of feet, cerebral palsy, spina bifida, arthrogyposis, and arthritic conditions. Medical justification is needed for valgus deformity of the feet
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Hip-knee-ankle-foot orthoses (HKAFO) and knee- ankle-foot orthoses (KAFO)
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Spina bifida, cerebral palsy, paraplegia, late effects of cerebrovascular accident (CVA), spinal cord lesions, arthrogryposis, club foot, varus deformities of feet, genu varus and genu valgus if due to growth deformity, and arthropathy associated with hematological disorder
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Hip orthoses (HO)
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Dislocated hip, cerebral palsy, spina bifida, and congenital deformities of the hip
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Inhibitive casting
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Cerebral palsy or any central nervous system deficit resulting in increased muscle tone in the extremities
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Knee orthoses (KO), knee immobilizer
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Arthropathy associated with hematological disorders related to lower extremity conditions
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Protective helmets
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Neoplasms of the brain, subarachnoid hemorrhage, subdural hemorrhage, hemophilia, epilepsy (if not well controlled), and cerebral palsy (severe)
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Spinal orthoses (SO), collars, corsets, and body jackets (TLSO, LSO, and LLSO)
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Scoliosis, spinal injuries, paraplegia, kyphosis, neurofibromatosis, cerebral palsy, spina bifida, and spinal tumor
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Thoracic-hip-knee-ankleorthoses (THKAO), parapodium, and swivel walker
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Spina bifida, spinal injuries, spinal tumor, cerebral palsy, and paraplegia
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Upper extremity orthoses, shoulder, elbow, wrist, hand, finger, and mobile arm support
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Cerebral palsy, spinal cord injury, brachial plexus lesions, nerve lesions, paralysis, juvenile rheumatoid arthritis, and reduction deformities
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