04/03/2017

CAM Walker Coverage with Fidelis

I have a patient with severe plantar fasciitis that was treated by 3 previous doctors all whom gave appropriate care via orthotics, night splints and injections. I opted to place the patient in a cam walker which worked. The patient had Fidelis and when I call for coverage am told they don't cover cam walkers. they cover orthotics and night splints but not cam walkers? Is this accurate?

The coverage for CAM walkers with Fidelis Care depends on the coverage that the patient has at the time of service:

• If the patient is enrolled in the commercial/metal plan through the insurance marketplace, patients have no coverage for DME under any circumstances and will be responsible for the cost of the item
• If the patient is enrolled in a Medicaid Managed Care plan or Medicare Advantage plan, Fidelis Care will cover two specific HCPCS codes for CAM walkers that need to be pre-authorized by the plan before payment will be made.
• L4361
• L4387
• L4360 & L4386 are not covered under any circumstances by the plan and will not be authorized for any provider type

**Please refer to the Quick Reference Guide-Fidelis Care Coverage Grid for Podiatry on the CPR Portal.