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Does Medicare Cover Prosthetics


Medicare covers a variety of prosthetics if they’re necessary to replace a body part or function.  Examples of prosthetics range from artificial teeth, eyes, facial bones, the palate, artificial hip, knee and other joints, legs, arms, and more. Below we’ll discuss WHICH prosthetics have coverage and HOW Medicare covers them.

Medicare Approved Prosthetics

Medicare covers many types of prosthetics, including:

  • Artificial limbs
  • Breast prostheses after a mastectomy
  • Cochlear implants and certain other types of surgically implanted prostheses
  • Ostomy bags and supplies
  • Eyeglasses or contact lenses after cataract surgery

Medicare Approved Prosthetic Devices

Medicare will provide coverage for prosthetic devices such as enteral and parenteral nutrition equipment & supplies, ostomy supplies, tracheostomy care supplies, urological supplies, cardiac pacemakers, speech aids, scleral shells, etc. Since each situation is unique to the beneficiary, talk with your doctor to see how much Medicare will cover.

Does Medicare Cover Prosthetic Legs?

Yes, Medicare will cover a prosthetic leg. Part B will cover the cost of the surgery if it’s done in an outpatient setting. If it’s done in an inpatient setting, then Part A will cover it.

You must get your prosthetic leg from a supplier that participates in Medicare. You’ll pay 20% of the cost, plus the Part A or Part B annual deductible. If you have a Medigap plan, it will help cover most, if not all, of your cost-sharing.

How Much Does a Prosthetic Leg Cost?

Many factors affect the cost of a prosthetic leg, including your age, size, typical activities, health, and materials and features. As a result, a prosthetic leg can cost anywhere from $5,000 to $50,000.

Further, the costs can vary depending on if you use other insurance, a facility that doesn’t accept Medicare, and your doctor’s fees. Discuss costs with your doctor beforehand.

How Much Does a Prosthetic Arm Cost?

Part B covers prosthetic arms the same as legs. You pay the premium and meet the deductible. Then, you pay 20% of the costs.

Like prosthetic legs, there is a wide array of options for prosthetic arms. Costs can range from around $3,000 to $30,000.But, advanced myoelectric arm costs fall around $20,000 to $100,000 or more depending on the technology. Medicare may not pay for advanced features if they’re not necessary.

If you want a 3D printed arm custom fit in about 40 hours, Open Bionics has the cost of the “Hero Arm,” starting around $3,000. But, they don’t have a clear indication of insurance acceptance.

Since they have private clinics, I imagine the costs are all out of pocket. Although, if you’re spending that much on a prosthetic even with coverage, that might be something to consider.

Does Medicare Cover Cranial Prosthetic?

Medicare doesn’t cover hair prosthesis unless it’s necessary for treatment. Since a wig won’t improve your health condition, it’s unlikely that insurance will cover any costs.

But, the cost of wigs for people going through cancer can be a tax-deductible expense, so save those receipts! Further, if you have an Advantage plan, you may get reimbursement for one wig.

Does Medicare Cover Cochlear Implants?

Medicare covers cochlear implants to improve hearing. Implants work differently than hearing aids. Cochlear implants can cost as much as $100,000 without insurance, but you can expect to pay much less if you have Medicare. Part B covers implants inserted in a healthcare provider’s office or outpatient facility.

Medicare will pay 80% of the Medicare-approved rate for the implants and surgery. If you have Medigap, that policy picks up the other 20%.

Does Medicare Cover Prosthetic Eyes?

Medicare covers prosthetic eyes if your doctor orders them. Part B will cover the surgical procedure to insert the implant into the orbital socket. Once you meet the Part B deductible, Medicare pays 80% of the cost.

Medicare will also cover replacement prosthetics every five years. In addition, Medicare covers polishing and resurfacing twice each year.

Does Medicare Cover Breast Prosthetics?

Medicare covers surgically implanted breast prostheses after a mastectomy. Part B also pays for external breast prostheses, bras, and post-surgery camis.

But, you must buy from a supplier that participates in Medicare. External breast prostheses need replacement periodically, and Medicare will pay for replacement devices.

Medicare adheres to this coverage schedule:

  • One silicone breast form every two years, or one foam breast form every six months
    • If you had surgery on both breasts, Medicare would pay for two
  • Mastectomy bras with a doctor’s prescription have coverage for about 4-6 bras each year
    • Medicare may cover new bras because of changes in your weight or other reasons
  • Up to three camis a month, if necessary

Does Medicare Cover Custom Breast Prostheses?

Medicare covers standard external breast prostheses. It won’t pay for custom versions, even for women having trouble with off-the-shelf products.

But, legislation has been introduced in Congress that would provide coverage. As of now, there is a CPT Code for custom breast prosthesis, but coverage isn’t available yet.

FAQs

What part of Medicare covers prosthetic devices?
Part A will cover anything related to prosthetics when done in an inpatient setting and Part B will cover anything related to prosthetics when done in an outpatient setting.
What kind of prosthetic legs does Medicare cover?
Medicare will cover any prosthetic leg device that your doctors find medically necessary.
How many prosthetic socks are allowed per year by Medicare.
You need a prescription for the replacement socks and the referring physician writes “as needed” on the prescription then Medicare will provide replacement socks for the patient. You need to take pictures of the worn-out socks so that you have proof you need replacements. As long as you can prove you need replacements, there is no limit on how many Medicare will cover.

Get Help Paying for Medicare Prosthetics

You have Medicare coverage options for prosthetics and any relating supplies that are unique to your situation. We can help you! Our team can find a plan that fits your health and budget needs. We’ll compare plan prices, answer questions, and help you in the right direction. Give us a call today at the number above or fill out an online rate form to get started.

Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

16 thoughts on “Does Medicare Cover Prosthetics

  1. Does Medicare pay for a second AK prosthetic leg after only 2 years when patient has gained weight. My sister prosthesis no longer fits well and she has a lot of phantom/ nerve pain when trying to wear it

    1. Hi Linda! Yes, as long as her doctor says it’s medically necessary, Medicare should cover it. Your best option is to have your sister contact Medicare directly while she is with her doctor to discuss what documentation they would require.

  2. What happens when the person who needs a prosthetic leg is on a disability income, which translate to no money whatsoever to pay for anything and is currently hobbling around on a leg that is black, blue,mpussing and bleeding?

  3. i have a patient who is in skilled nursing facility under MedA skilled. the prosthetic company will not give the patient their prosthetic until he is off med A or the facility agrees to pay. I am under the understanding that it can still be billed to medB even if he is under services of medA

    1. Hi Theresa! The prosthetic is considered Durable Medical Equipment, which would fall under Part B. The prosthetic company cannot bill the Skilled Nursing Facility since they are only providing inpatient services under Part A. Your patient would need to have the prosthetic “prescribed” by a physician at an outpatient facility so the prosthetic company can bill the outpatient facility under Part B. The prosthetic company cannot get paid by Medicare under Part A for services rendered at an inpatient facility. In some cases, an inpatient facility can bill for Part B services. However, a DME provider cannot bill Part A for Durable Medical Equipment. I hope this helps!

  4. Does Medicare cover a nurse to do intermittent catheterization for a home bound patient age 82 with urinary retention, ordered by a urogynecologist, for a short term period while the cause is further worked up by physicians? She cannot catheterize herself.

    1. Hi Kirsten! Yes, as long as the urogynecologist says it’s medically necessary and presents Medicare will the correct documentation and treatment plan.

  5. does medicare cover any of cost for bathroom remodel i.e. seat height toilet, walk in shower for an amputee. my brother is having leg amputed this wednesday 6/17/2020 due to infection in leg. Also a new mattress will be needed for his bed at home when he returns. his mattress on the bed now is very high from ground. does medicare cover any of this cost? thank you

    1. Hi Susan! Medicare does cover some Durable Medical Equipment for bathroom safety. As long as your doctor finds it medically necessary, Medicare may help pay for the cost or reimburse you for some of it. I would start by speaking to your doctor about what documentation they can provide that will help show Medicare it’s medically necessary. This works the same with the mattress. I hope this helps!

      1. Hi Jen! Medicare will cover a prosthetic leg if it’s surgically implanted in an inpatient or outpatient facility. If it’s done in an inpatient facility, then it falls under Part A. If it’s done in an outpatient facility, it will fall under Part B.

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