Lower Extremity Prosthetics – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers external lower‑extremity prostheses that replace a limb when medically necessary under the member’s benefit plan and InterQual® criteria, but excludes fully implanted devices, osseointegrated percutaneous systems (e.g., OPRA), certain microprocessor knee‑shin systems for K1/K2 patients, combined powered microprocessor ankle‑foot systems, sport/safety‑only devices, and replacements due to misuse/loss. Coverage requires documentation per InterQual CP: Durable Medical Equipment, Prosthetics, Lower Extremity and MFCL/K‑level assessment (K0–K4)—microprocessor knees are supported for K3 community ambulators—and payment is limited to the device meeting the member’s minimum functional specifications and plan terms.

"A lower extremity prosthetic for amputations is proven and medically necessary in certain circumstances. For medical necessity clinical coverage criteria, refer to the InterQual® CP: Durable Medica..."