Prosthetic devices

Medicare Part B (Medical Insurance)

covers prosthetic devices needed to replace a body part or function when a doctor or other health care provider enrolled in Medicare orders them.

Prosthetic devices include:

Breast prostheses (including a surgical bra).
One pair of conventional eyeglasses or contact lenses provided after a cataract operation.
Ostomy bags and certain related supplies.
Some surgically implanted prosthetic devices, including cochlear implants.
Urological supplies.

Your costs in Original Medicare

You pay 20% of the

Medicare-Approved Amount

for external prosthetic devices, and the Part B

deductible [glossary]

applies. Medicare will only pay for prosthetic items furnished by a supplier enrolled in Medicare. It doesn't matter who submits the claim (you or your supplier).

note:

Some states may require prior authorization for certain types of lower-limb prosthetics before Medicare will pay.

Call 1-800-MEDICARE (1-800-633-4227) for more information.

note:

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

Other insurance you may have
How much your doctor charges
Whether your doctor accepts assignment
The type of facility
Where you get your test, item, or service

Things to know

You must go to a supplier that’s enrolled in Medicare for Medicare to pay for your device. Part A or Part B covers surgically implanted prosthetic devices depending on whether the surgery takes place in an inpatient or outpatient setting.

Medicare will only pay for prosthetic items furnished by a supplier enrolled in Medicare, no matter who submits the claim (you or your supplier).

Prosthetic devices

note:

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Is my test, item, or service covered?

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