Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
List also available in PDF format.
See Treatment Guidelines and Resources for additional information.
Dynamic Offloading Brace is a custom ankle foot orthosis (AFO) made primarily from carbon fiber. It provides both elements of offloading and energy storing. A dynamic offloading brace may help to improve functional performance in certain injured workers with complex ankle injuries.
Conditions of Coverage (all the following conditions have to be met):
- Covered indications include: complex ankle injury with or without peripheral nerve injury such as crush injury, multiple failed surgeries, ankle fusion, fractures (tibial, pilon, talus, calcaneus) or partial foot amputations (midfoot or hindfoot).
- Recommended by a MD or DO board certified in physical medicine or orthopedic surgery with expertise in functional rehabilitation.
- Determined to be necessary to promote/allow for return to work or to prevent amputation.
- Other standard brace/orthotic options have been attempted without success.
- No other surgical options are being pursued (such as hardware removal and fusion).
- Worker has the ability to travel to clinic and participate in training.
Implementation of the Coverage Decision
The device may be used only for care of a condition accepted on the claim. All requests for a dynamic offloading brace for complex ankle injury require prior authorization.