Prosthetics - Medicare Advantage

This Medicare Advantage policy covers prosthetic devices and related services — including limb prostheses (intended for amputations at the transmetacarpal level or higher), maxillofacial, ocular, testicular and nasal prostheses, orthopedic footwear, and custom components — for patients with amputation, congenital absence, trauma, pain, restricted mobility, recurrent socket infections, short stumps, socket retention issues, soft tissue scarring, or volume fluctuation. Coverage is subject to applicable CMS National and Local Coverage Determinations and MAC jurisdictional LCDs/LCAs (member benefits may vary), requires use of specified HCPCS/L-codes (with coding restrictions such as L5679 not for locking mechanisms), and does not supersede reviewing medical director judgment or current CMS guidance.

"54660 - Insertion of testicular prosthesis (separate procedure)"