How does Medicare define prosthetics and orthotics, and under what circumstances are they covered?
Medicare defines prosthetic and orthotic devices as “leg, arm, back, and neck braces, and artificial legs, arms, and eyes, including replacements if required because of a change in the beneficiaries The orthotics benefit regarding braces is limited to leg, arm back and neck braces that are used independently of other medical or non-medical equipment. In order for an orthosis to be covered by Medicare, it must be a rigid or semi-rigid device that is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. An orthosis can be either prefabricated or custom fabricated. Covered orthotics must be reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member. Payment is prohibited for medical services that are for prevention, palliation, research or experimentation. Prostheses are covered when furnished incident to physicians’ serv
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