CurrentAmeriHealth CaritasPolicy CCP.1174

Dynamic Movement Orthoses (Suit Therapy)

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This policy governs coverage determinations for dynamic movement orthoses, also called suit therapy, including lycra-based therapeutic garments used for motor-related movement problems. AmeriHealth Caritas considers the policy with plan benefits, applicable laws, regulations, and individual clinical circumstances when making determinations.

Policy Summary

PayerAmeriHealth Caritas

PolicyDynamic Movement Orthoses (Suit Therapy)

Policy CodePolicy CCP.1174

Change TypeAdministrative and evidence-review update

Effective DateJul 1, 2026

Last ReviewJul 1, 2026

Next Review DateNov 1, 2027

Key ActionDo not consider dynamic movement orthoses or suit therapy medically necessary because they are investigational or not clinically proven.

SourceLink

POLICY UPDATE CHANGES

In 2020, the policy added absolute and relative contraindication statements to guide medical necessity determinations where permitted by state Medicaid authority.

In 2026, the policy references were updated and no new relevant information or coverage policy changes were identified.

Not medically necessaryCoverage stance

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CurrentAmeriHealth CaritasPolicy CCP.1174

Dynamic Movement Orthoses (Suit Therapy)

Customize your policy alerts

Sign up for AmeriHealth Caritas Policy CCP.1174 alerts

Get alerted when Policy CCP.1174 changes without checking for updates manually.

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Policy Summary

PayerAmeriHealth Caritas

PolicyDynamic Movement Orthoses (Suit Therapy)

Policy CodePolicy CCP.1174

Change TypeAdministrative and evidence-review update

Effective DateJul 1, 2026

Last ReviewJul 1, 2026

Next Review DateNov 1, 2027

Key ActionDo not consider dynamic movement orthoses or suit therapy medically necessary because they are investigational or not clinically proven.

SourceLink

POLICY UPDATE CHANGES

In 2020, the policy added absolute and relative contraindication statements to guide medical necessity determinations where permitted by state Medicaid authority.

In 2026, the policy references were updated and no new relevant information or coverage policy changes were identified.

Not medically necessaryCoverage stance

Coverage Criteria

Dynamic Movement Orthoses (Suit Therapy)

Dynamic movement orthoses (suit therapy) are not covered as medically necessary.

Not medically necessary: Dynamic movement orthoses (suit therapy) are investigational/not clinically proven and, therefore, not medically necessary.

The policy does not establish a covered clinical indication or exception.

Absolute contraindications to the use of lycra-based suit orthoses include severely restricted pulmonary function, refractory cyanosis, and lycra allergy.

Relative contraindications to the use of lycra-based suit orthoses include severe reflux symptoms, uncontrolled epilepsy, cardiovascular circulatory disorders, diabetes, high-degree spasticity, hip dislocation, severe scoliosis, hydrocephalus, myopathies, progressive encephalopathies, and psychiatric or behavioral disorders.

Dynamic movement orthoses, also called suit therapy, are considered investigational/not clinically proven. Therefore, they are not medically necessary under this policy.

Related Codes

Related codesHCPCS

A4467	Belt, strap, sleeve, garment, or covering, any type.
L1200	Thoracic-lumbar-sacral-orthosis (TLSO), inclusive of furnishing initial orthosis only.

Provider Considerations

Denial Risk

Suit therapy is not medically necessary

Dynamic movement orthoses, also called suit therapy, are considered investigational or not clinically proven and therefore are not medically necessary. Requests for these devices are at risk of denial under this policy.

Denial Risk

Screen for absolute contraindications

Do not use lycra-based suit orthoses when an absolute contraindication is present, including severe restricted pulmonary function, refractory cyanosis, or lycra allergy.

Severe restricted pulmonary function
Refractory cyanosis
Lycra allergy

Clinical Background

Dynamic movement orthoses are lycra-based garments intended to provide stabilization and proprioceptive input to support coordinated movement. They are used as an alternative to traditional bracing and have been studied primarily in children with cerebral palsy and other motor-related movement disorders, often in combination with intensive physical therapy. Available evidence consists largely of small observational studies and low-quality randomized studies and does not permit reliable conclusions about the benefits or harms of therapy.

Key Definitions

Dynamic movement orthoses

MaterialLycra-based devices

UseAn alternative to traditional bracing for people who have not responded well to traditional bracing

StabilizationStabilize the torso to support coordinated movement of the limbs

Movement supportChange the positions of certain body parts and add weight to help inform the body how to move correctly

Suit therapy

Alternate termDynamic movement orthoses

ExamplesStabilizing pressure input orthosis, Adeli suit, Penguin suit, Polish suit, Therapy suit, TheraSuit, and TheraTogs