MedicaidCoverageHigh impact
Orthotics - MEDICAID - VIRGINIA (New)
Humana·VA · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy +1 more·Medicaid
Effective date
Jul 1, 2025
We identified it
Jun 24, 2026
Summary
New Humana Medicaid policy for Virginia establishes coverage criteria for various orthotic devices including braces, splints, and supports. The policy details specific HCPCS codes and medical necessity requirements for lower extremity, foot, and spine orthotics effective July 1, 2025.
Action Required
By July 1, 2025: Billing team must update systems with new Humana Virginia Medicaid orthotic coverage criteria. Update prior authorization requirements for custom orthotics requiring detailed clinical documentation (L2106, L2108, L2126, L2128, L3649). Add medical necessity checklists to EMR for static AFOs, hip orthoses, and cervical halos. Train providers on required goniometer measurements and stretching program documentation for plantar flexion contractures. Claims without proper documentation will be denied.