Prosthetic devices

Medicare Part B (Medical Insurance)

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

Examples of prosthetic devices include:

Your costs in Original Medicare

After you meet the Part B deductible, you pay 20% of the 

Medicare-Approved Amount

 for external prosthetic devices.

note:

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

 

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
  • If your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service
Things to know

For Medicare to pay for your prosthetic device, you must go to a Medicare-enrolled supplier. This is true no matter who submits the claim (you or the provider). Either Part A or Part B covers a surgically implanted prosthetic device depending on if the surgery takes place in an inpatient or outpatient setting.

 

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