Medicare Coverage of Orthotics and Prosthetics

What It Is

Orthotic and prosthetic devices for replacement or support of a body part

What's Covered

Medicare Part B covers orthotic and prosthetic devices, including artificial limbs and eyes; braces for arm, leg, back, and neck; and breast prostheses and related supplies following a mastectomy.

Medicare Part B covers orthopedic shoes if they're a medically necessary part of a Medicare-covered orthotic leg brace. Prosthetic shoes are covered by Medicare Part B if they're an integral part of a prosthesis for patients with a partial foot amputation.

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 co-payments for orthotics and prosthetics, contact the plan directly.

What Medicare Pays

Medicare Part B pays 80 percent of the Medicare-approved amount for covered orthotics and prosthetics.

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

  • The care 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 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 must be performed or delivered by a healthcare provider who participates in Medicare.

Was this medicareinformation helpful?

7 Comments So Far. Add Your Wisdom.

9 months ago

My afo for foot drop is causing callus with ulcer on foot,now infected. Will medicare help pay in new drop foot brace that is less invasive? Any help appreciated. The present afo was made in Oct 2013 Adjustments made but still causes problems with foot and skin on leg. Thank you

over 1 year ago

I have a prosthesis that doesn't fit right. I want to go to a different doctor to get a new one. Does medicare cover a second prosthesis? I got this one in 2009 and I couldn't never wear it. It rubs my leg raw.

over 1 year ago

Husband has multiple sclerosis and has been advised that custom orthotics will help with stability and neuropathy of his feet. He is on disability and has Medicare plus private secondary insurance. Will Medicare help cover the cost of the orthotics and shoes?

almost 4 years ago

Just a thank you for having this information available for those of us who need it.

over 4 years ago

I need help getting Medicare to pay for insoles that was ordered by a doctor . I had a broken foot and was very painful and next to impossible to walk. Thanks

over 4 years ago

This is very useful information for people who have to use prosthetic devices. However dealing with medicare post-payment audits can be costly, ineffective and unrealistic as told in the following article:

over 4 years ago

Thanks for sharing this information! The more useful and knowledgeable information about custom orthotics online the better. Keep up the good work! Dr. Michael Horowitz, Vancouver Orthotics


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