AFOs that are custom-fabricated are covered for ambulatory patients when the basic coverage criteria listed and one of the following criteria are met: The patient could not be fit with a prefabricated AFO, or The condition necessitating the orthosis is expected to be permanent or of longstanding duration (more than 6 months), or There is a need to control the knee, ankle or foot in more than one plane, or The patient has a documented neurological, circulatory, or orthopedic status that requires custom fabricating over a model to prevent tissue injury, or The patient has a healing fracture which lacks normal anatomical integrity or anthropometric proportions.
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