Will Medicare pay for a new ankle foot orthosis whenever I need one? - Candace F.
We wish it were that easy! The determining factor for whether or not there is a Medicare benefit depends on the reason a new orthosis is being ordered by a physician. Has your medical condition changed and your current orthosis no longer meets your medical needs? If yes, Medicare will provide a benefit for a new one. However, if it’s simply because you want a new orthosis, then no, Medicare will not pay for a new one. Medicare also considers a 5 year Reasonable Useful Lifetime policy in regards to normal wear and tear of lower limb orthoses. What does this mean? If you have had your current orthosis for less than 5 years and it is simply showing signs of normal wear and tear, Medicare will not pay for a replacement and you would be financially responsible for the cost of a new one. It is important to note that the five year period begins with the date the device is delivered to you, as that is the date used on the claim submitted to Medicare.
Provided we receive an accurate medical history and appropriate insurance information from you, you can rest assured our Patient Services Coordinators will apply their extensive insurance knowledge to your service and will notify you of any financial responsibility you may have prior to proceeding with the service. If your service is in process and there is a change to your insurance benefit, we will immediately notify you of any changes to your financial responsibility, as well. We are committed to inform you of your insurance coverage, as well as any financial responsibility you may have, each and every time you receive care from us. Have a great summer!
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