CSHCN Services Program 2010 > Orthotic and Prosthetic Devices > Benefits, Limitations, and Authorization Requirements

   
 

27.2.2 Orthoses

The following orthoses may be reimbursed:

Orthoses
Covered Diagnosis and Condition

Ankle-foot orthoses (AFO), plastic or metal

Foot anomalies, cerebral palsy, hemiplegia, spina bifida, club foot, arthrogryposis, and arthropathy associated with extremity conditions

Dynamic splints

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.

Foot orthoses

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

Hip-knee-ankle-foot orthoses (HKAFO) and knee- ankle-foot orthoses (KAFO)

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

Hip orthoses (HO)

Dislocated hip, cerebral palsy, spina bifida, and congenital deformities of the hip

Inhibitive casting

Cerebral palsy or any central nervous system deficit resulting in increased muscle tone in the extremities

Knee orthoses (KO), knee immobilizer

Arthropathy associated with hematological disorders related to lower extremity conditions

Protective helmets

Neoplasms of the brain, subarachnoid hemorrhage, subdural hemorrhage, hemophilia, epilepsy (if not well controlled), and cerebral palsy (severe)

Spinal orthoses (SO), collars, corsets, and body jackets (TLSO, LSO, and LLSO)

Scoliosis, spinal injuries, paraplegia, kyphosis, neurofibromatosis, cerebral palsy, spina bifida, and spinal tumor

Thoracic-hip-knee-ankleorthoses (THKAO), parapodium, and swivel walker

Spina bifida, spinal injuries, spinal tumor, cerebral palsy, and paraplegia

Upper extremity orthoses, shoulder, elbow, wrist, hand, finger, and mobile arm support

Cerebral palsy, spinal cord injury, brachial plexus lesions, nerve lesions, paralysis, juvenile rheumatoid arthritis, and reduction deformities


Texas Medicaid & Healthcare Partnership
CPT only copyright 2009 American Medical Association. All rights reserved.
PreviousNextIndex