LCDActive
Facial Prostheses
L33738
Noridian Healthcare Solutions, LLC (J19)
Effective: January 1, 2020
Updated: December 31, 2025
Policy Summary
Medicare covers facial prostheses when there is loss or absence of facial tissue due to disease, trauma, surgery, or congenital defect, provided the item falls within a Medicare benefit category and is reasonable and necessary. Coverage requires appropriate documentation including a completed (and when required signed) Standard Written Order/WOPD prior to billing or delivery, correct HCPCS coding, and maintained proof of delivery; claims missing these elements will be denied.
Coverage Criteria Preview
Key requirements from the full policy
"Facial prosthesis is covered when there is loss or absence of facial tissue due to disease, trauma, surgery, or a congenital defect."
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