Prosthetic and Orthotic Devices and Supplies

40.6 - Prosthetic and Orthotic Devices and Supplies (Rev. 111, Issued: 09-25-09; Effective Date: 07-07-08; Implementation Date: 10-26- 09) Prosthetic devices, other than dental devices and renal dialysis machines, are covered CORF services if they are included in the rehabilitation plan of treatment. Prosthetic devices (other than dental) are defined as devices that replace all or part of an internal body organ (including contiguous tissue), or which replace all or part of the function of a permanently inoperative or malfunctioning internal body organ. If the patient’s medical record, including the judgment of the physician, indicates the condition is of long and indefinite duration, the test of permanence is considered met. Coverage of a prosthetic device includes all services necessary for formulating its design, material, and component selection; measurement, fittings, static and dynamic alignments; and instructing the patient in its use. Such coverage is included as an integral part of the fabrication of the device. Orthotic devices include but are not limited to leg, arm, back, and neck splints or braces. They are rigid and semi-rigid devices supporting weak or deformed body members or restricting or eliminating motion in a diseased, dysfunctional, or injured body part. Elastic stockings, garter belts, and similar devices do not come within the scope of the definition of an orthotic or a device. Back braces include, but are not limited to, special corsets, e.g., sacroiliac, sacrolumbar, dorsolumbar corsets and belts. Examples of prosthetic devices include artificial legs and arms. Residual limb stockings and harnesses (including replacements) are also covered when these appliances are essential to the effective use of the artificial limb. In general, orthotics and prosthetics are covered when furnished in conjunction with a physician's service or on a physician's order. These devices are covered CORF services if included as part of the rehabilitation plan of treatment. The payment for an orthosis or prosthesis includes its design, materials, measurements, fabrications, testing, fitting, adjustments and training in the use of the device. Adjustments to an artificial limb or other appliance required by a change in the patient's condition are covered when ordered by the patient’s referring or CORF physician. Adjustments, repairs and replacements in these cases are covered even when the item had been in use before the beneficiary enrolled in Medicare Part B so long as the device continues to be medically required. CORFs may not bill separately for the supplies they furnish except for those cast and splint supplies that are used in conjunction with the corresponding Current Procedural Terminology code.