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MedicallyModern

Orthotics & Bracing

Orthopedic Braces & Supports, Covered by Insurance

Knee, back, ankle and wrist bracing, CAM boots, and post-mastectomy bras and breast prostheses, fitted and billed for patients throughout New York. Under Medicare a brace must meet the orthosis benefit definition and the item-specific medical-necessity and coding requirements, we work from your practitioner's order to the correct code.

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Hinged knee brace, lumbar back brace and CAM walking boot covered by Medicare with a physician's order

Key takeaways

  • After the Part B deductible, patients generally owe 20% of the Medicare-approved amount unless secondary coverage pays it. We verify your current benefits and provide an estimate of your expected out-of-pocket cost before shipment. Benefit information is not a guarantee of payment; final coverage and patient responsibility are determined when your plan processes the claim.
  • 3 orthotics & bracing bundles available, billed to Medicare, New York Medicaid, and major commercial plans.
  • Same-day benefit verification, with your expected out-of-pocket sent to you in writing before anything ships.
  • Delivery across the five boroughs, Long Island, Westchester, Putnam County, Dutchess County including Poughkeepsie, and all of New York. Eligible supplies can be shipped statewide. Items requiring measurement, customization, fitting, or adjustment are handled through an in-person delivery or fitting process.

What we offer

Braces, supports and mastectomy products covered by Medicare

  • Orthopedic Braces & Supports (Back, Knee, Ankle-Foot, Wrist & Cervical)

    Lumbar supports, hinged and unloader knee braces, AFOs, wrist splints, and cervical collars for arthritis, injury, post-surgical recovery, and neurologic conditions.

  • Immobilizers (CAM Boots, Slings)

    CAM walker boots, shoulder slings, and immobilizers for fractures, sprains, and post-operative protection.

  • Mastectomy Bras, Forms & Camisoles

    Post-surgical camisoles, mastectomy bras, and silicone breast forms fitted after breast surgery, billed under the benefit that applies to your coverage.

Coverage explained

How brace coverage and documentation works

Under Medicare, a brace must meet the orthosis benefit definition, generally a rigid or semi-rigid device used to support a weak or deformed body part or to restrict motion, and also satisfy the item-specific medical-necessity and coding requirements for the code being billed. Documentation alone is not the whole test. Mastectomy products follow separate authority: the Women's Health and Cancer Rights Act applies to certain group and individual coverage that provides mastectomy benefits, while Medicare separately covers qualifying external breast prostheses under its prosthetic-device benefit.

  1. 1

    Practitioner order and benefit category

    The record must show the diagnosis, the joint or region involved, and that the ordered device meets the orthosis definition and the medical-necessity criteria for its code, not simply that a brace was requested.

  2. 2

    Correct product code and fit

    The wrong billing code means a denial. We identify the payer's documentation requirements, request the existing records, and ask the treating clinician to address any missing clinical elements based on their independent evaluation. We then bill the code that matches the ordered brace and confirm sizing before it ships.

  3. 3

    Mastectomy product allowances

    Allowances for post-surgical bras and external breast prostheses are set by the specific payer, Medicare's prosthetic-device benefit and each health plan's mastectomy benefit each publish their own quantities and replacement intervals. We confirm your payer's allowance and eligibility dates and tell you what they are.

  4. 4

    Replacement and repair

    Braces wear out. Replacement is not automatic: we re-verify your plan's replacement rules, ask your practitioner for a current order when one is required, and tell you what is covered before reordering.

What patients typically pay

After the Part B deductible, patients generally owe 20% of the Medicare-approved amount unless secondary coverage pays it. We verify your current benefits and provide an estimate of your expected out-of-pocket cost before shipment. Benefit information is not a guarantee of payment; final coverage and patient responsibility are determined when your plan processes the claim.

Want the specifics for your plan? Read how our insurance process works or check your coverage.

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Why Medically Modern

Why patients choose Medically Modern for orthotics & bracing

Many preventable delays involve missing documentation, prior authorization, quantity limits, or supplier participation; some denials reflect true exclusions or unmet criteria. We identify the payer's documentation requirements, request the existing records, and ask the treating clinician to address any missing clinical elements based on their independent evaluation. We support or submit an appeal where permitted and authorized.

  • In-network with all major insurances

    Medicare, Medicaid, and the major commercial carriers. We verify your current benefits and provide an estimate of your expected out-of-pocket cost before shipment. Benefit information is not a guarantee of payment; final coverage and patient responsibility are determined when your plan processes the claim.

  • White-glove, high-touch service

    A named care coordinator who contacts your doctor's office and handles prior authorization. We support or submit an appeal where permitted and authorized. You never sit on hold chasing paperwork.

  • Qualified fitting and documentation support

    Braces and mastectomy products are fitted by trained staff and billed under the code the ordered device matches. We identify the payer's documentation requirements, request the existing records, and ask the treating clinician to address any missing clinical elements based on their independent evaluation.

Orthotics & Bracing covered by the plans we bill every day

  • Medicare A&B
  • NY Medicaid
  • Aetna
  • Humana
  • Fidelis
  • NYSHIP Empire
  • Anthem BCBS
  • MagnaCare
  • UnitedHealthcare

Participation varies by plan and product, we verify your specific plan before anything ships.

Plus most regional Medicaid, Medicare Advantage, and commercial plans. Not sure? We'll check for you.

Orthotics & Bracing FAQ

Brace and mastectomy product coverage questions

Official coverage sources

Read the payer rules directly, then let us verify what your own plan allows.

Medicare Part B covers knee orthoses when the device meets the orthosis benefit definition and the item-specific criteria for the code billed, and the practitioner documents a qualifying diagnosis such as osteoarthritis, ligament instability, or post-surgical recovery.

Lumbar and lumbar-sacral orthoses are covered when the device meets the orthosis definition, the specific code's medical-necessity criteria are met, and the practitioner documents a qualifying spinal condition, not simply general back pain.

Those unsolicited offers bill Medicare under your number whether or not the brace fits your diagnosis, and they often lead to a denial or an unexpected bill for you. We only supply a brace your own physician has ordered, and we tell you your cost before anything ships.

Medicare covers qualifying external breast prostheses and post-surgical bras under its prosthetic-device benefit with an order. Separately, the Women's Health and Cancer Rights Act applies to certain group and individual coverage that provides mastectomy benefits. We confirm which authority applies to your coverage and what it allows.

Quantities and replacement intervals are set by the payer, so the answer depends on whether Medicare's prosthetic-device benefit or a health plan's mastectomy benefit applies to you. We confirm your payer's published allowance and your eligibility dates before ordering.

Yes. We fit and bill bracing and mastectomy products for patients across the five boroughs, Long Island, Westchester, Putnam County, Poughkeepsie, and all of New York.

Often, yes. Many preventable delays involve missing documentation, prior authorization, quantity limits, or supplier participation; some denials reflect true exclusions or unmet criteria. We identify the payer's documentation requirements, request the existing records, and ask the treating clinician to address any missing clinical elements based on their independent evaluation. We support or submit an appeal where permitted and authorized.

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Other ways we help

Explore all nine categories

One supplier, nine insurance-covered product lines.