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.

Archived Coverage Decisions.

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.