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.