Does Medicare Cover Prosthetics?

Which part of Medicare pays for prosthetics?

Most prosthetic devices fall under the Part B (Medical Insurance) prosthetic device benefit. Part B covers devices that replace a body part or a body function when a doctor or other qualified provider orders them as medically necessary.

The main exception is a prosthesis that is surgically implanted during a hospital stay. If you are admitted as an inpatient, Part A (Hospital Insurance) covers the surgery and the implanted device. If the same procedure is done on an outpatient basis, Part B applies. For example, a surgically implanted breast prosthesis is covered by Part A when the surgery is inpatient and by Part B when it is outpatient. Cochlear implants and other surgically implanted devices follow the same inpatient-versus-outpatient rule.

What prosthetic devices does Medicare cover?

Medicare's prosthetic device benefit is broad. As long as a device is medically necessary and ordered by your provider, Part B generally helps pay for it.

• Artificial limbs — prosthetic legs and arms, when medically necessary and ordered by a doctor.
• Artificial eyes — covered when medically necessary and ordered by a provider.
• External breast prostheses — including a post-surgical (surgical) bra after a mastectomy.
• Surgically implanted breast prostheses — Part A if inpatient, Part B if outpatient.
• Ostomy supplies — bags and certain related supplies for people who have had a colostomy, ileostomy, or urinary ostomy.
• Urological supplies — covered under the prosthetic device benefit.
• Cochlear implants and other implanted prosthetic devices — Part A or Part B depending on the setting.
• Enteral and parenteral nutrition — nutrients, supplies, and equipment such as feeding pumps.
• One pair of eyeglasses or contact lenses — only after covered cataract surgery that includes an intraocular lens.

How much do prosthetics cost with Medicare in 2026?

Under Original Medicare, you first pay the annual Part B deductible, which is $283 in 2026. After that, you pay 20% of the Medicare-approved amount, and Medicare pays the other 80%. There is no separate yearly dollar cap on this coinsurance under Original Medicare.

The Medicare-approved amount is the lower of the supplier's actual charge or the fee Medicare sets on its fee schedule, and your 20% is calculated from that approved amount — not the sticker price. To keep Part B (which covers prosthetics), you also pay the standard monthly Part B premium, which is $202.90 in 2026.

A simple example: if the Medicare-approved amount for a prosthetic leg is $10,000 and you have already met your deductible, your 20% share would be $2,000 and Medicare would pay $8,000. A Medigap (Medicare Supplement) policy can help cover that 20% coinsurance.

Supplier rules, prior authorization, and documentation

For Medicare to pay, you must obtain your prosthetic device from a Medicare-enrolled supplier — this is true no matter who actually submits the claim. Using a non-enrolled supplier can leave you responsible for the full cost.

You also need a doctor's order documenting that the device is medically necessary. For lower limb prostheses, Medicare's medical-necessity criteria are spelled out in Local Coverage Determination L33787.

Certain lower limb prosthetics require prior authorization before Medicare will pay. Specific items identified by their HCPCS codes (L5856, L5857, L5858, L5973, L5980, and L5987) have required prior authorization nationwide since December 1, 2020. More broadly, CMS maintains a Required Prior Authorization List for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS); as of April 13, 2026, that list includes 74 items. Your supplier usually handles the prior authorization paperwork, but it is wise to confirm before the device is ordered.

Repairs, adjustments, and replacement

Medicare covers adjustments to a prosthesis that are needed because of normal wear or a change in your medical condition. Repairs are also covered when they are necessary to make the prosthesis functional again.

Whether and how often a prosthesis can be replaced depends on medical necessity and Medicare's coverage rules for the specific device, rather than a single universal time limit. If your condition changes or a device wears out, talk with your provider and supplier about documenting the need for repair or replacement.

Medicare Advantage and what is NOT covered

Medicare Advantage (Part C) plans must cover at least the same prosthetic benefits as Original Medicare. However, your costs, provider networks, and prior-authorization rules can differ from plan to plan. If you have a Medicare Advantage plan, check your plan's Evidence of Coverage and use in-network, plan-approved suppliers, and confirm any prior-authorization steps with the plan first.

One important exception: dental prosthetics such as dentures are generally NOT covered under the Part B prosthetic device benefit. Routine dental care and dentures are handled separately from this benefit; some Medicare Advantage plans offer dental coverage, but it varies by plan, so confirm details before assuming dentures are included.