MedicaidCoverageHigh impact
Orthotics - MEDICAID - FLORIDA (New)
Humana·FL · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy +2 more·Medicaid
Effective date
Nov 5, 2025
We identified it
Jun 24, 2026
Summary
Humana has released a new Medicaid policy for Florida that establishes comprehensive coverage criteria for various orthotic devices including braces, splints, supports, and custom orthotics. The policy defines medical necessity requirements and covers specific HCPCS codes for lower extremity, foot, and spine orthotics.
Action Required
Before November 5, 2025: Billing team must update billing system to include medical necessity requirements for all listed orthotic HCPCS codes for Florida Medicaid patients. Providers must document specific clinical criteria (e.g., goniometer measurements for L4631, fracture details for L2126/L2128). Update encounter forms and EMR templates to include required documentation elements. Claims without proper medical necessity documentation will be denied.