Orthotics Research Studies and Information

Download Reference Documents

There are many useful research studies that show orthotics are an effective part of a treatment plan. Foot Levelers has many on their website in the Provider’s Portal section. These are a small sampling of the more significant studies and information to support orthotics prescription in your practice. Download, review and save these for your reference.

Chiropractic Adjustments Orthotics Reduced Symptoms
FL Low Back Orthotic Study
Immediate Changes in the Quadriceps Femoris Angle After Insertion of an Orthotic Device
Orthotic Insole Use and Patient Satisfaction
Radiographic Evaluation of the Effect of Orthotics

Clinical Best Practices for Orthotics

Start By Scanning Every New Patient

We know that when the foot hits the ground, everything changes. Providers must consider the feet, which are the foundation of the patient’s spine when evaluating the musculoskeletal system relative to the patient’s complaints. Best practice is to scan every patient at the beginning of their episode of care.

The valuable data collected with the 3D, digital scan is the most important starting point. Not only does the scan measure the arches of the feet, but also indicates degrees of pronation or supination and many other measurements that demonstrate medical necessity for functional orthotics. Whether the provider elects to order the functional orthotics right away or include them in later recommendations, this important scan provides information to support the prescription of chiropractic care as well. We recommend that your foot scan becomes an integral part of the evaluation, just as vital signs are “automatic.” The following steps are recommended to identify additional, important details to support the provider’s recommendations.

Evaluate Medical Necessity and Document Your Clinical Decision Making

Documentation of medical necessity of care starts with the patient’s history. When considering whether functional orthotics are medically necessary, and therefore a covered service, insurers often look to the patient history to document the following symptoms where present:

    • joint pain/stiffness
    • weakness
    • limitation of motion
    • difficulty walking
    • numbness/tingling in the lower extremities

It is important when taking a patient’s history to explore both past and current medical conditions that may affect patient care. Chronic conditions and traumatic injuries could each benefit from functional orthotics. Additionally, it may be helpful to ask the patient about other treatments tried or considered and ruled out. Where applicable, document why these prior alternatives did not work out favorably, or why they stopped working.

These are some examples of specific history questions that may be helpful in determining the need for functional orthotics:

    • Are your symptoms affected by walking, standing, or climbing stairs?
    • Do you avoid activity due to pain in your feet or lower extremities?
    • Do you have to elevate your feet to get comfortable?
    • Do you use any type of home remedies for your feet and lower extremities?
    • Have you tried heel lifts, over the counter (OTC) analgesics, OTC insoles, rigid orthotics, padding, changing your shoes, or injections?

The answers to these questions, when properly documented in the patient record, may help support your assessment that treatment is indicated and there is medical necessity for prescribing functional orthotics.

Examination And Diagnostic Testing

Once the patient’s history is established, the next step is the physical examination, with the testing driven by what was learned in the history. The history, combined with documentation of the physical examination and, where called for, diagnostic testing (i.e., X-rays) together provides the objective evidence for medical necessity to support the use of functional orthotics in a treatment program. When orthotics are being considered, your documentation must clearly describe the patients’ symptoms and medical diagnoses. You may also include one or more of the following:

    • 5 Red Flags of Pronation
    • Global postural distortions
    • Structural X-ray anomalies
    • Functional squat test
    • Range of motion
    • Orthopedic/Neurological tests
    • Digital foot/posture assessment

Click here to access an excellent Functional Foot Evaluation form to best document clinical findings.

Proper Diagnosis

Functional orthotics address not only conditions of the feet, legs, and hips but also conditions of the spine. Most often, insurance coverage is limited to diagnoses specific to extremities vs. spinal conditions. For this reason, we urge providers to be aware of the diagnosis requirements for medical necessity when attempting to assist the patient with receiving reimbursement from a third-party payer. The Medical Review Policy (MRP), published by the payer, should outline all the requirements. If the patient’s condition is not included in the medically necessary diagnosis list, not to worry. The patient still needs functional orthotics! Simply prescribe them as you would otherwise. In this course, we provide a list of diagnosis codes that have appeared in various payer MRP. However, this list is not exhaustive and shouldn’t be relied upon as the definitive list of appropriate diagnosis codes.

Treatment Plan

To establish medical necessity and the clinical appropriateness of functional orthotics, include your recommendations in the context of a broader treatment plan. A properly written treatment plan should be comprehensive and may include some of the following elements:

    • Recommended level of care to include duration and frequency of follow-up visits
    • Methods of treatment to be utilized (i.e., adjustments, therapies, functional orthotics, rehab)
    • Specific treatment goals, including goals for the functional orthotics
    • Objective measures to evaluate treatment effectiveness and the effectiveness of functional orthotics
    • Planned modalities and procedures, including those adjunctive treatments to support the necessity of functional orthotics

Finally, ensure that your initial or ongoing assessment indicates the provider’s reasoning for prescribing functional orthotics. This is where providers lay out the analysis of the data obtained throughout this evaluation process, culminating in the recommendation for functional orthotics.

**This is an excellent article and page of information about best practices: https://www.chiroeco.com/custom-orthotics-for-flat-feet/


Orthotics and Their Clinical Applications

Everything begins with the patient history and evaluation. When including the potential for custom orthotics in your patient’s treatment plan, begin with careful and comprehensive documentation of the patient’s condition. It includes asking the right questions and documenting important findings. This overview tutorial outlines the most important clinical aspects of the health record that may support the need for custom, functional orthotics.


The Decision Point- Insurance or Cash?

Gather the Facts

Some patients’ insurance may cover functional orthotics, but more often, there are caveats to consider. Many payers are moving to a model in which all Durable Medical Equipment (DME) must be dispensed through an in-network DME Supplier in order to be covered. Some require that the prescription for the DME is only valid when ordered by an allopathic physician rather than a Chiropractor or other type of provider. Therefore, it’s critical to verify all insurance coverage thoroughly, asking all the right questions, to determine whether the patient’s benefits include functional orthotics. Be sure to check with each individual carrier as well as your state scope of practice that may require a spinal-related diagnosis, an extremity-related diagnosis, or both.

A Thorough Verification of Benefits

As with all aspects of Chiropractic care, a simple verification of coverage is never enough when dealing with orthotic coverage. Simply asking or reviewing whether a patient’s benefits include orthotics can leave a gaping hole in the information required to receive payment. For that reason, a multi-step process is recommended to protect the practice and the patient before ordering functional orthotics.

Follow these steps for success.

    • When– Verification of benefits can happen before your patient comes in. You can copy the orthotics verification template page and place it on the back side of your existing verification form. Collect necessary information on the intake phone call and pre-verify benefits. For practices that scan every new patient, as recommended, verify orthotic benefits right along with other chiropractic benefits. Then, if functional orthotics are ordered, you have all the information necessary to bill and collect properly.
    • What– To get all the answers you need, specific questions must be asked in a very specific way. For that reason, we’ve supplied a template verification form for your use. The questions on this form are carefully curated to guide you through the potential land mines associated with orthotics billing. We urge you to follow the form exactly, adding additional questions as they may relate specifically to your office.
    • Where– Reviewing an online benefits portal is probably not enough to get you all the information you’ll need to bill orthotics. Basic coverage information is rarely sufficient to help you know all the nuances that may be in play. We urge you to always check for the Medical Review Policy (MRP) for Orthotics and Prosthetics on the Payer’s website. It will delve into the specifics of which diagnoses are covered and under what circumstances orthotics are considered medically necessary.
    • Why– Once you have reviewed that MRP, investigate the patient’s specific benefits. The form will direct you to questions such as the allowed fee per foot, which codes are covered, co-insurance percentage, and additional ancillary services that may be covered. This deeper dive is important to arm you with all the information needed for successful billing.

Now What?

So, what happens if your investigation reveals that the patient doesn’t have full insurance coverage for functional orthotics or the patient’s diagnosis is not consistent with coverage? This happens quite often, but it doesn’t mean the patient’s needs change. Now is the time for the provider to prescribe, regardless of coverage, and as with all care, have your teamwork with patients to make the orthotics affordable within their family budget. The next page explains some options for self-pay patients.


Coverage & Benefits Considerations

Just because someone has insurance coverage for other healthcare, there is no guarantee that coverage is available for Durable Medical Equipment (DME) like custom orthotics. And then, even if there is orthotic coverage, there may be restrictive limitations on the conditions for which orthotics may be prescribed. Sometimes, the payer requires DME to be dispensed by a licensed DME supplier to be a covered benefit. This overview tutorial calls attention to the most important considerations when reviewing coverage for your patients for the potential coverage of custom orthotics through their health plan. It also includes a demonstration on how to find the Medical Review Policy for orthotics, if one exists. Download and refer to the sample Reference Document which is an example of the details in some payers’ Medical Review Policy for orthotics.

Download Reference Document

Sample Medical Review Policy (MRP) for Orthotics