As of June 12, 2025 Minnesota Medicaid revised their Orthotics and Prosthetics Policy. The policy has been amended to include more comprehensive criteria for HCPCS codes L2005 and L2006. Both codes require authorization and are considered lower limb orthotics. The criteria are listed below:
“Custom-fabricated knee-ankle-foot orthoses (KAFOs) with automatic lock and swing-phase release (L2005) and microprocessor-controlled KAFOs (L2006) are covered with authorization if all of the following criteria are met:
- The member is ambulatory and use of a KAFO is appropriate; and
- The member has cardiovascular, cognitive, and physical ability to use the device; and
- Documentation articulates reasonable likelihood of improved mobility or stability with the device instead of a standard KAFO; and
- Documentation articulates need for ambulation and how device enhances member’s ability to perform activities of daily living (ADLs); and
- Consideration of less costly alternatives; and
- A trial demonstrates the member is able to use the device”