Prosthetics - MEDICAID - VIRGINIA

Humana Medicaid's Prosthetics policy covers medically necessary prosthetic devices and supplies to restore prior function for ADLs, with specific covered items including ear/face prostheses, ocular prostheses and keratoprosthesis, certain lower-limb components (eg, hip joint for K3 ambulator), OPRA for transfemoral amputees meeting strict inclusion/exclusion criteria, select upper- and lower-limb prosthetic components, diagnostic test sockets (up to 2), and repair/replacement under defined conditions. The policy lists numerous exclusions and limitations (custom breast/nipple prostheses, duplicate devices, devices for activities beyond ADLs, certain microprocessor or adjustable components, immediate test sockets, LUKE arm and upper-limb osseointegration, MyoPro orthoses, etc.) and specifies documentation requirements for eligibility (age, etiology, functional level/K-level, EMG/microvolt thresholds, evidence of inability to use conventional sockets, absence of contraindications for OPRA, proof of medical necessity and manufacturer coverage status).