Medicare Coverage of Braces (arm, leg, back, neck)


What It Is

An arm, leg, back, or neck brace used by a patient at home

What's Covered

Medicare Part B pays for the rental or purchase of an arm, leg, back, or neck brace if prescribed by a doctor. The equipment must be rented or purchased from a Medicare-certified medical equipment supplier.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different copayments for a brace, contact the plan directly.

What Medicare Pays

Medicare Part B pays 80 percent of the Medicare-approved amount for rental or purchase of an arm, leg, back, or neck brace, and the patient is responsible for the remaining 20 percent.

Warning:** If a device is rented from what's called a Medicare "participating supplier," the supplier can't charge more than the Medicare-approved amount. However, a supplier who's enrolled in Medicare but isn't an officially participating supplier may charge more than the Medicare-approved amount. In that case, the patient must personally pay the difference between the Medicare-approved amount and the amount the supplier actually charges (on top of the 20 percent of the Medicare-approved amount that Medicare doesn't pay).

Important: Regardless of the rules regarding any particular type of care or equipment, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care or equipment must meet two basic requirements:

  • The care or equipment must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care or equipment is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care or equipment must be provided by a healthcare provider or equipment supplier who participates in Medicare.

Was this medicareinformation helpful?

2 Comments So Far. Add Your Wisdom.

over 1 year ago

I NEED A BACK BRACE ,HOW CAN I GET ONE


over 1 year ago

i am a retired pt, who has devised a new type of brace. optimally, i hope to license it to a supplier who is medicare approved. I will sell to suppliers and contemplating selling to individuals. what kind of cms qualification do I need for: distribution as a suppliers or, distribution to individuals both as prescribed by a physician? I have a code as per coding by medicare, can I assign the code or does it all have to be reviewed by medicare? thank you


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