Lower Limb Prostheses - Policy Article

Lower limb prostheses are covered when they meet Medicare benefit eligibility and are reasonable and necessary per the related LCD, and must also meet statutory payment rules (including documentation requirements). Prostheses provided and used during Part A inpatient or qualifying SNF stays are generally included in facility payments under specified conditions and HCPCS codes; DME MAC coverage requires specific timing, documentation, WOPD, and classification criteria. Routine servicing is noncovered, certain items (e.g., donning sleeve L7600) are denied, repairs and replacements are covered under defined thresholds and practitioner order requirements, and items subject to Final Rule 1713 require a face-to-face encounter and WOPD prior to delivery.

"A lower limb prosthesis is covered when it meets Medicare benefit eligibility and is reasonable and necessary per the related Local Coverage Determination (LCD)."