Orthotic ALJ Denial

Tom Heckman

Hello List;

I just received a negative decision at the Administrative Law Judge level
for custom made AFOs provided in October of 2011. They were provided to a
33 yr old man with lumbar level spina bifida for whom we have been
fabricating braces since he was 2 years old. He has been a functional
ambulator his entire life due in part to his orthotic treatment. He has
what those of you familiar with spina bifida would recognize as feet that
could not possibly fit into any kind of prefabricated device. He satisfies
virtually every criteria outlined in the Medicare LCD dealing with AFOs.
Beware!

Tom Heckman CO, LO (Ohio)

 

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