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AetnaCommercial · Coverage · DME · Podiatry, OrthopedicsMedium impact

Foot Orthotics (CPB 0451, reviewed 2026-07-16)

Effective date
Not stated in the notice
Identified
Aug 17, 2026

Summary

Aetna covers foot orthotics for plans that do not exclude them when the member has a listed condition such as plantar fasciitis, calcaneal spurs, chronic ankle instability or a musculoskeletal foot deformity, has symptoms from that condition, and has not responded to appropriate conservative treatment such as physical therapy, injections, strapping or anti-inflammatory medications. Most Aetna plans exclude orthopedic shoes and foot orthotics, with exceptions for prosthetic shoes, therapeutic shoes that are an integral part of a covered leg brace, and rehabilitative foot orthotics prescribed as part of post-surgical or post-traumatic casting care. Therapeutic shoes and inserts are considered medically necessary for members with diabetes mellitus and a foot deformity, pre-ulcerative calluses, previous ulceration, peripheral neuropathy with callus formation, poor circulation or previous amputation of the foot, with no more than one pair of custom-molded shoes and two additional pairs of inserts, or one pair of depth shoes and three pairs of inserts, per member per calendar year. Foot orthotics have no proven value for back pain, knee pain other than medial osteoarthritis, adult pes planus, pronation, corns and calluses, hip osteoarthritis or lower leg injuries, and 3D-printed insoles, Apostherapy, Orpyx sensory insoles, Spinal Pelvic Stabilizers and UNFO-S are considered experimental, investigational or unproven.

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What to do

Action · 10 steps
01Billing team: Before a claim is submitted for a foot orthotic, confirm that a Standard Written Order was communicated to the supplier first, because a claim billed without a completed SWO will be denied as not medically necessary.
02The SWO must include the member's name or identification number, the order date, a general description of the item (HCPCS code, HCPCS narrative or brand name and model number), every concurrently ordered option or accessory that is separately billed, the HCPCS code and quantity for each item, and the treating practitioner's name, national provider identifier (NPI) and signature.
03Keep proof of delivery on file for each foot orthotic billed, because proof of delivery must be available to Aetna on request and services without appropriate proof of delivery will be denied as not medically necessary.
04Get a new prescription from the treating practitioner each time a new device or repair is requisitioned, since a prosthetist, orthotist, orthotic fitter, pedorthotist, physical therapist or occupational therapist is not considered a treating practitioner.
05Keep enough medical record information to show that all applicable coverage criteria are met, because a practitioner's order, a supplier-prepared statement or a practitioner attestation by itself does not establish medical necessity.
06For custom fabricated foot orthotics, document why the member's needs cannot be met with prefabricated (custom fitted) or prefabricated off-the-shelf foot orthotics.
07Bill L3000 for the UCB-type insert with a heel cup of at least 10 mm, L3010 or L3020 for a removable insert with a heel cup under 10 mm (L3010 for longitudinal arch support, L3020 for longitudinal and metatarsal support), and L3030 for an insert formed directly to the patient's foot with an external heat source.
08Limit each affected foot to one L3000 every two years for adults, since replacement is generally not necessary more often than every 2 years.
09Do not bill orthotics made on the same date as an open cutting surgical procedure, such as a bunionectomy, and bill only one orthotic per foot with no separate orthotics for each pair of the member's shoes.
10Over-the-counter orthotics are covered as supplies for plans that do not exclude foot orthotics only when prescribed by a physician and used for short-term acute conditions.

Codes mentioned

L3000L3010L3020L3030L3161A9283A5508L84M35.7

Original notice

Foot Orthotics (CPB 0451, reviewed 2026-07-16)
aetna.com · Always check the source before changing claims.
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Related changes

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Hammertoe Repair (CPB 0636, reviewed 2026-09-11)LowNo effective date · Medical PolicyHammertoe Repair (CPB 0636, reviewed 2025-12-11)LowNo effective date · Medical PolicyRoutine Foot Care (CPB 0046, reviewed 2026-04-07)MediumNo effective date · Medical PolicyPlantar Fasciitis Treatments (CPB 0235, reviewed 2026-04-27)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesPodiatryOrthopedicsCode L3000Code L3010Code L3020Code L3030Code L3161Code A9283Code A5508Code L84Code M35.7

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