Where do I start?
Your medical provider may recommend or order an orthotic for you. They can directly contact an orthotics provider, or you can contact an orthotics provider of your choice.
The orthotics provider needs a detailed written order signed and dated by your medical provider for all orthotic services. For therapeutic shoes, inserts, and modifications for diabetics, your medical provider should fill out the MassHealth Orthotic and Prosthetic Prescription and Medical Necessity Review Form for Therapeutic Shoes, Inserts, and Modifications (ORT-D). For foot orthoses, footwear (including orthopedic shoes), and modifications for nondiabetic members, your medical provider should fill out the MassHealth Orthotic and Prosthetic Prescription and Medical Necessity Review Form for Foot Orthoses, Footwear, and Modifications (ORT-ND). In some cases, an orthotics provider might need to follow up with your medical provider to get a corrected or more complete document.
Prior authorization
Many orthotic items require prior authorization (PA). This means MassHealth will determine if the item is medically necessary. The orthotics provider will let you know if PA is needed. If MassHealth denies your PA, we’ll send you a letter of denial to the address that we have on file for you. The letter will include instructions for how to appeal the decision.
Delivery of orthotics
The orthotics provider will coordinate delivery of your orthotics after they get all needed documentation or PA for the item.
Repair or replacement of orthotics
Contact your orthotics provider if you need repairs for any equipment that MassHealth covers for you. MassHealth covers replacement orthotics when the existing equipment no longer meets your medical needs, or if the repairs cost more than replacing the item.
What types of ORT does MassHealth cover?
MassHealth covers orthotics used to support, align, correct, or prevent deformities of the body. The orthotics may be used to eliminate, control, or assist motion at a joint or body part. They must be appropriate for you to use at home or where your normal life activities take place in the community.
MassHealth may cover these orthotics:
- Addition to lower-extremity orthosis
- Ankle-foot orthosis ankle gauntlet
- Axillary crutch extension
- Benesch boot
- Cranial cervical orthosis
- Diabetic inserts
- Diabetic shoes
- Foot arch support
- Foot insert
- Gradient compression stockings
- Gradient compression stockings garter belt
- Gradient compression stockings wrap
- Heel pad
- Heel wedge
- Helmet
- Knee orthosis immobilizer
- Lift elevation inside shoe
- New leather or rubber heal
- Orthopedic footwear
- Orthopedic shoe
- Peroneal straps
- Sole wedge
- Stocking supporter grips
- Surgical boot
- Thoracic rib belt
MassHealth may also cover other orthotics. Talk to your medical provider if you need an item you don't see on this list.
MassHealth doesn’t cover the following orthotics:
- Nonmedical items. These are items that are used primarily and normally for a nonmedical purpose. These are not considered orthotics, even if the item has a medically related use;
- Therapeutic shoes for diabetics that aren’t listed on the PDAC Product Classification List, with an associated HCPCS code;
- Orthotics that won’t significantly help your condition or how you perform your activities of daily living; or
- Orthotics that are used for research or are experimental.
Who do I contact if I need help?
MassHealth Customer Service Center
Contact the MassHealth Member Customer Service Center if you need help with:
- Eligibility
- MassHealth benefits
- Replacing your MassHealth card
- Enrolling in a health plan
- Getting a MassHealth application
- MassHealth and Children's Medical Security Plan premiums
Phone: (800) 841-2900, TDD/TTY: 711
My Ombudsman
My Ombudsman can assist any MassHealth member with questions or challenges accessing covered benefits or services.
Phone: (855) 781-9898
Videophone: (339) 224-6831
My Ombudsman website
| Date published: | December 8, 2025 |
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