Facial Prostheses - Policy Article

Medicare covers facial prostheses under the Artificial Legs, Arms and Eyes benefit when the device is reasonable and necessary and LCD R&N requirements are met; adhesives and related supplies used with the prosthesis are also covered. Initial fabrication, materials, delivery-time modifications, repairs and follow-up within 90 days are included in the prosthesis allowance and not separately billable; replacements, repairs for accidental damage or extensive wear beyond 90 days, and modifications required by a change in condition after 90 days may be separately payable subject to documentation, coding, modifier, jurisdiction, and WOPD/face-to-face requirements.

"Facial prostheses are covered under the Medicare Artificial Legs, Arms and Eyes benefit (SSA §1861(s)(9)) when the prosthesis is reasonable and necessary for the diagnosis or treatment of illness o..."

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