Prosthetics - MEDICAID - KENTUCKY

This policy covers prosthetic replacement of missing body parts — including upper and lower limb prostheses (feet, knees, multiaxial feet, SACH), maxillofacial devices, and associated systems such as vacuum-assisted socket systems (VASS/LimbBionic) for residual limb volume management. It applies to patients with limb loss or functional issues (short or scarred stumps, socket retention problems, volume fluctuation, pain, and community/active ambulators) but is subject to member plan overrides and specific limits/requirements — e.g., up to two diagnostic/test sockets per prosthesis, exclusions for pregnancy and body weight over 220 lb (including prosthesis), and device-specific functional limitations (such as SACH feet on uneven terrain); additional coverage details are referenced but not provided in the excerpt.

"No specific documentation requirements are provided in this excerpt."