Upper Extremity Prosthetic Devices – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers external upper‑extremity prosthetic devices (including myoelectric hands/partial‑hands below the wrist when simulator operability and minimum EMG/muscle control thresholds are met, and above‑wrist myoelectrics only with InterQual® approval) but excludes osseointegrated/bone‑anchored implants as unproven, fully implanted devices, items for sports/safety only, and repairs/replacements for misuse, loss, or gross neglect. Coverage requires documented amputation or congenital absence, a physician order and prosthetist evaluation, demonstrated functional benefit with ADL/IADL assessment, patient willingness/ability to train, required documentation (e.g., EMG/simulator results, prosthesis prescription and physician authorization), and selection of the device that meets the member’s minimum functional specifications.

"If more than one prosthetic device can meet the member's functional needs, benefits are available only for the prosthetic device that meets the minimum specifications for the member's needs; if the..."