Understanding the medical necessity criteria outlined in the medical coverage policy of private payers will help you provide appropriate documentation to suppor...

Where to Find Medical Coverage Policies | O&P Reimbursement

Understanding the medical necessity criteria outlined in the medical coverage policy of private payers will help you provide appropriate documentation to support your patient’s medical needs. Most payers to make their policies available online. You and your team should familiarize yourself with payers in your town and understand the policies covering the services you provide.

Below are links to some of the policies for the large, national payers.

Myoelectric Upper Extremity Prosthetic Devices Clinical Guideline

Prefabricated and Prophylactic Knee Braces Clinical Guideline

Upper Extremity Myoelectric Clinical Guideline

Microprocessor Controlled Lower Limb Prosthesis Clinical Guideline

Custom Made Knee Braces Clinical Guideline

Ankle-Foot and Knee-Ankle-Foot Orthoses Clinical Guidelines

 You may find other policies by searching for “medical coverage policy” and the insurance company name.