New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 55 - PROSTHETIC AND ORTHOTIC SERVICES
Subchapter 1 - GENERAL PROVISIONS
Section 10:55-1.7 - Policy on footwear
Universal Citation: NJ Admin Code 10:55-1.7
Current through Register Vol. 56, No. 18, September 16, 2024
(a) For purposes of the New Jersey Medicaid and NJ FamilyCare programs policies, an "orthopedic shoe" means footwear, with or without accompanying appliances, used to prevent or correct gross deformities of the feet, which is properly fitted as to length and width, and consists of the following basic parts:
1. Correct straight last line;
2. Heels with sufficient bearing surface;
3. Toe with ample room for function;
4. Sole of sufficient weight for foot protection;
5. Rigid shank;
6. Properly fitting upper;
7. Smooth and protective lining; and
8. Snug fitting heel counter.
(b) Orthopedic footwear shall be reimbursable under the following conditions:
1. When attached to a brace or bar; and/or
2. When part of the normal (customary, usual) postoperative or postfracture treatment program; and/or
3. When used to correct or adapt to gross foot deformities.
(c) All footwear shall be consistent with the styles of footwear provided by manufacturers approved by the Federal Centers for Medicare and Medicaid Services (CMS)-approved Pricing Data Analysis and Contract Center.
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