Prosthetic Devices - Coverage Definition (Rev. 1, 10-01-03)

by  Jared Staheli
June 17th, 2015

Prosthetic devices (other than dental) are covered under Part B as a medical or other health service (§1861(s)(8) of the Act) and are devices that replace all or part of an internal body organ or replace all or part of the function of a permanently inoperative or malfunctioning internal body organ. Replacements or repairs of such devices are covered when furnished incident to physicians' services or on a physician's orders.

For detailed coverage requirements (including definitions and discussion) associated with the following prosthetic device terms and circumstances see the Medicare Benefit Policy Manual, Chapter 15:

• "Test of Permanence"

• "Prosthetic Lenses"

• "Intraocular Lenses (IOLs)"

• "Supplies, Adjustments, Repairs and Replacements"

For coverage information on specific situations and prosthetic devices, see the Medicare National Coverage Determinations Manual.

References:

• Pub 100-04 Medicare Claims Processing Manual