Facial Prostheses, External

Aetna covers removable superficial external facial prostheses (nasal, mid‑facial, orbital) and related adhesives/adhesive removers/tape for loss/absence of facial tissue from disease, trauma, surgery, or congenital defect, but excludes cosmetics/skin‑care products (e.g., HCPCS A6250, A6260) and other non‑medical items. The prosthesis allowance includes evaluation, preop planning, materials, fabrication/fitting labor, modifications/repairs and follow‑up within 90 days of delivery (not separately reimbursed); modifications are separately payable only if >90 days after delivery and medically necessary due to a change in the member’s condition.

"Superficial facial prosthesis when there is loss or absence of facial tissue due to disease, trauma, surgery, or a congenital defect, regardless of whether the facial prosthesis restores function."

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