L3221 Orthopedic mens shoes dpth iOrthopedic footwear, mens shoe, depth inlay, each
7 of 7 payer prior-auth lists that name L3221 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | State of Arizona employee group (SYD, S3Z) | AZ | prior auth required | Sep 1, 2026 | State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) | |
| UnitedHealthcare Community Plan | Indiana Hoosier Care Connect | IN | prior auth under conditions | Prior authorization required only for orthotics and prosthetic codes listed with a retail purchase or cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Indiana PathWays for Aging (MLTSS) | IN | prior auth under conditions | Prior authorization required only for orthotics and prosthetic codes listed with a retail purchase or cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for Indiana MLTSS Pathways Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Massachusetts OneCare | MA | prior auth under conditions | Prior authorization is required only for orthotics codes listed with a retail purchase or cumulative rental cost of more than $1,000. | Nov 1, 2025 | Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025 |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) | MA | prior auth under conditions | Prior authorization is required only for orthotics codes listed with a retail purchase or cumulative rental cost of more than $1,000. | Nov 1, 2025 | CPT® is a registered trademark of the American Medical Association. Prior authorization requirements for Massachusetts Senior Care Options Effective November 1, 2025 |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) and OneCare | MA | prior auth under conditions | Prior authorization is required only for orthotics codes listed with a retail purchase or cumulative rental cost of more than $1,000. | Oct 1, 2026 | Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Texas STAR+PLUS | TX | prior auth required | Jan 1, 2019 | Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p |
L3221 appears in 4 coverage policies from Aetna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Bunionectomy (0629) | listed, no stance (range L3201-L3265) | Sep 11, 2026 | payer document |
| Aetna | Foot Orthotics (0451) | covered if criteria are met (range L3201-L3265) | Jul 16, 2026 | payer document |
| Aetna | Pedobarography (0294) | listed, no stance (range L3000-L3649) | Apr 17, 2026 | payer document |
| Aetna | Plantar Fasciitis Treatments (0235) | listed, no stance (range L3000-L3265) | Apr 27, 2026 | payer document |
Prior authorization required or conditional in CO, KY, LA, MA, MD, ND, NY, OH, VA, WV.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.