Orthotic Insurance Coverage Questions

Many insurance carriers cover the cost of one or more pair of custom foot orthotics as they can be an effective treatment for many foot and ankle conditions (along with some leg, knee, hip and back conditions).

Often, the use of orthotics can eliminate the need for long term drug therapy, physical therapy or surgical correction. Thus, they are covered by many insurance plans as therapeutic and preventive medical devices.

To determine your orthotic insurance coverage you can contact your insurance carrier and ask the questions below.

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Your insurance will require the following codes to determine coverage:

• Procedure Code for custom foot orthotics:  L3000-RT and L3000-LT    (right and left orthotics)

Questions to Ask Your Insurance Company

• Are custom foot orthotics (code L3000) covered with your insurance plan? ___Yes ___No
• If foot orthotics are covered, are they covered at 100%, 80% some other percentage or a specific amount / maximum amount? ________________
• Are there any exclusions? eg:  Do I have to be diabetic? ___Yes ___No     If YES what are exclusions: ______________________________
• Do you cover a pair of orthotics if the condition only affects one foot? (note: If your insurance fails to cover one orthotic the cost to you is $249)

• Is prior authorization required before your insurance will cover the orthotics? ___Yes ___No
• If yes, what is required for pre-authorization? ___Letter from our office. (For a pre-authorization letter please call our bookkeeper) ___Phone call ___ Other ______________________________________
  • If a letter is required where do we fax or mail it? ________________________________
• If orthotics are covered, how many pair per lifetime are covered? __________   ___unlimited
  • How many pairs per calendar year (Jan -Dec) ______  OR pairs per 12-month period: ________  
• Do you have a deductible? ___Yes ___No
• Has your deductible been met? ___Yes ___No   If no, how much is due on deductible? $____________
• Do you have a health savings account as part of your insurance plan? ___Yes ___No
• Name of insurance company contact person_______________________ Date Called:____________
  • Phone Number: ________________________
  • FAX Number:____________________________

Do you need a first pair or additional pair of custom orthotics?

First Pair of Orthotics

If we have never made custom orthotics for you before you will need to make an appointment to see us for an evaluation and imaging of your feet. Appointment information can be found below

Additional Pair of Orthotics

If we have made custom orthotics for you before then the image of your foot is usually on file and we can usually (but not always) order additional orthotics for you without an appointment. Ordering information is below.

We are open for in-office and telehealth appointments

To make an in-office or telehealth appointment:

• Log into our portal to make an in-office appointment online (for telehealth appointments you will need to call us)
• Call us at 206-344-3808 for in-office or telehealth appointments 

To order additional orthotics you can do one of the following:

• Call our office at 206-344-3808, press 2.  A message can be left 24 hours per day.   
• Use this Online Orthotic Order Form
•  Log into our portal and send a note requesting new orthotics

Our staff will send you a message via our patient portal after receiving your orthotic request.

Discount on additional pairs of orthotics if insurance does not cover

If your insurance does not cover more than one pair of orthotics, there is a substantial self-pay discount on additional pairs after the first pair. Cost information on both first and additional pairs of orthotics is available on our price list here.  

Insurances that never cover orthotics

A majority of insurance carriers in the Seattle area have some orthotic coverage. The following insurances, however, are ones that never cover foot orthotics under any situation.

• Medicare
• Medicare supplement plans
• Medicare advantage plans
• Regence UNIFORM (most other Regence plans do cover orthotics)
• Kaiser
• Molina for adults (children under 16 often have coverage)
• United Health Care Community Plan