Lower Limb Prostheses

Aetna covers lower‑limb prostheses (e.g., SACH and single‑axis feet for K1+) only when medically necessary and excludes devices for K0 patients, user‑adjustable heel‑height features, and routine/appearance‑related foot‑cover replacements; replacements are covered only if the current prosthesis fails to meet medical needs or is unrepairable, only one axial rotation unit per ankle is allowed, and foot covers are included in the foot component (repair/replacement only for damage, not for appearance/comfort/misuse, and no more than one replacement per year). Coverage requires a prescription within six months by a qualified prescriber, provision by a licensed/ABC/BOC‑certified orthotist/prosthetist, documentation that the device will restore mobility‑related ADLs, and that the member is motivated and likely to attain/maintain the required K‑level function within a reasonable time.

"Product information (manufacturer, part number or part name) for prosthetic components must be recorded in the medical records."