Section 16.03.09.773 - PROSTHETIC AND ORTHOTIC SERVICES: PROCEDURAL REQUIREMENTSProsthetic and orthotic devices and services will be paid for only if prescribed by a physician or non-physician practitioner. The following information must be included in the order and kept on file by the provider:
01.Full Description of the Services Requested.02.Number of Months the Equipment Will Be Needed and the Participant's Prognosis.03.Participant's Medical Diagnosis and Condition. The participant's medical diagnosis and the condition that requires the use of the prosthetic or orthotic services, or both, supplies, equipment or modifications, or both; and04.Modifications to the Prosthetic or Orthotic Device. All modifications must be supported by the attending physician's description on the prescription.Idaho Admin. Code r. 16.03.09.773