Medicare resting AFO question

Medicare resting AFO question

Randy McFarland

12/30/2015

I have a patient with a wound at her posterior heel. She rests in bed in
plantarflexion and when PT gets her up to a standing position the wound gets
stretched and opens up when the ankle is dorsiflexed. She is able to
ambulate but is restricted due to her wound opening up. The patient is on a
stretching program. I understand that resting AFOs generally aren't covered
by Medicare when prescribed just to relieve for wounds.

 

This orthosis was ordered to position the foot in plantigrade so the wound
can heel in the same angle as when pt is standing so it won't get stretched
open again when she walks.

 

Have any of you had success in receiving Medicare reimbursement for a
similar situation? I you are a Medicare claims reviewer, will such a claim
be approved or denied?

 

Thanks, and Happy New Year!

Randy McFarland,CPO

Fullerton, CA