Orthotics

The Department requires that orthotic services be provided by a licensed occupational therapist, a licensed physical therapist, certified orthotist or prosthetist (American Board for Certification) or an accredited orthotist (Board for Orthotist Certification) when an orthotic device is prior authorized.

An Orthotic Device is defined as a mechanical device which is intended and fashioned to support or correct any defect or deformity or to improve the function of movable parts of the body and generally known as a “brace” or orthosis”. The orthotic device must be specifically ordered by a physician or PCP and may not be standard equipment used by the general population.

PA is required for all custom-molded orthotics. The amount paid for orthotics and prosthetics shall be 97% of the lowest of:

1. The maximum Maine Care amount published at least annually on the Department's website and made available to providers;
2. The lowest amount paid by Medicare;
3. The provider’s usual and customary charge; or
4. The manufacturer’s suggested retail price (including replacement parts).

The following limitations apply to Maine Care members twenty-one (21) years of age and older:

1. Shoes inserts, supports, wedges or modifications are limited to two (2) units per year (one per foot per year).
2. Orthopedic Shoes are limited to pair a year.
3. Shoe Modification Lifts are limited to eight (8) one inch increments per year.
4. Abduction rotation bars are limited to one per year.

Note: Limits for insert lifts and supports are limited to a total of one (1) per foot per year. Limits for shoes of all types are one (1) shoe per foot per year.

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