Medicare.gov

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.

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

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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