Confusion Over Orthotic Coverage in New Jersey

Several days ago I received a panicky call from a New Jersey orthotic manufacturer. He stated that one of his clients (a DPM) called him, very concerned that Horizon Blue Cross Blue Shield of New Jersey was going to discontinue foot orthotic coverage as of January 1, 2027. I found this very interesting, as a New Jersey Law, enacted in 2025, mandates foot orthotic coverage in the state when the prescriber deemed it medically necessary. The law provides very liberal coverage for foot orthotic coverage. See: https://www.nj.gov/humanservices/notices/documents/rules-and-regulations/NJAC%2010_57%20PODIATRY%20SERVICES.PDF

Prior to researching Horizon’s new policy, I had the good sense to think back to my days in podiatry school in the mid 1970s, when rumors constantly played havoc with our young impressionable minds. It seems that in podiatry these “vicious podiatric rumors” as we labeled them, would never end. And so, in 2026 they continue.

I informed my client to stay cool. Having completed the research, it appears that Horizon’s new policy is in fact in line with the 2025 law and does not eliminate or seriously reduce foot orthotic coverage. It does not apply to patients under 21 and applies to those with the following coverage:

• Horizon BCBSNJ commercial fully insured plans

• Braven Health℠ plans

• Administrative Services Only (ASO) employer group accounts, including the New Jersey State Health Benefits Program (SHBP) and School Employees’ Health Benefit Program (SEHBP) plans

• Federal Employee Plans® (FEP®) plans.

For L3000: Horizon cites a limit of two (2) units, which I am assuming is two for the left and two for the right. For other popular foot orthotic codes L3010, L3020, and L3030 there is a four (4) unit limit. Again, I am assuming that is per anatomical side. For all codes, the assumption of units of a minimum of two per side is derived directly from the New Jersey law. Anything lower than two per side would be inconsistent with the law. 

Why did Horizon enact this new policy? It is to abide by the law and reduce fraud and abuse for a few providers in New Jersey who were abusing the lack of edits? These few were billing five or more pairs for the average adult patient, with minimal changes in the orthotic prescriptions.

I implore New Jersey podiatrists and other orthotic providers not to abruptly switch to L3010 or L3020 simply due to any perceived (real or imagined) economic advantage. Auditors predictably would be looking for wholesale changes in billing patterns of orthotic claims. Thus, I am happy to say that this “vicious podiatric rumor” is dead! Long live foot orthotic coverage in New Jersey!

For the rest of the nation, it serves as a valuable lesson: November and December should be spent looking for any insurance policy changes for the upcoming year. Patients deserve to know whether a service is covered or not. If not covered, they deserve to know their financial responsibilities.

—Paul Kesselman, DPM