Facial Prostheses

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.

"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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