Medicare AdvantageCoverageMedium impact
Orthotics - Medicare Advantage (Revised)
Humana·Orthopedics, Physical Therapy, PM&R (Physical Medicine & Rehab) +1 more·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Aug 4, 2026
Summary
Humana has revised its Medicare Advantage Orthotics policy (HUM-1177-006), effective August 3, 2026. This policy establishes coverage requirements and guidelines for orthotic devices including braces, splints, casts, and advanced technologies (exoskeletons, microprocessor-controlled devices, myoelectric orthotics). The policy references specific CMS Local Coverage Determinations and requires providers to follow Medicare's 'reasonable and necessary' standard for all orthotic claims.
Action Required
By July 14, 2026 (policy review date): Billing team must review and verify alignment with CMS Local Coverage Determinations L33686 (Ankle-Foot/Knee-Ankle-Foot Orthosis), L33318 (Knee Orthoses), and L33790 (Spinal Orthoses: TLSO and LSO) within applicable DME MAC jurisdictions. Verify that current billing processes for all orthotic devices align with the geographic jurisdiction rules (DME A, B, C, D) mapped to your practice location. Update internal documentation requirements to reflect Humana's reference to CMS Medicare Benefit Policy Manual Chapter 15, Section 130. Ensure all orthotic claims submitted include medical necessity documentation supporting 'reasonable and necessary' treatment. Failure to comply may result in claim denials for orthotics lacking proper clinical justification.