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Prosthetic Devices, Wigs, Specialized, Microprocessor or ...
Prosthetic devices , wigs , specialized , Microprocessor or myoelectric Limbs Page 1 of 21 UnitedHealthcare Commercial Coverage Determination Guideline Effective 01/01/2022 Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc. UnitedHealthcare Commercial Cover a ge Deter mina tion Guideline Prosthetic devices , wigs , specialized , Microprocessor or myoelectric Limbs Guideline Number: Effective Date: January 1, 2022 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Documentation Requirements .. 5 Definitions .. 6 Applicable Codes .. 7 References .. 20 Guideline History/Revision Information .. 20 Instructions for Use .. 20 Coverage Rationale Indications for Coverage Implantable devices /prostheses, such as artificial heart valves, are not prosthetics. If covered, these devices would be covered as a surgical service. Prosthetic devices An initial or replacement Prosthetic device is a covered health care service when all of the following criteria are met: The Prosthetic device replaces a limb or a body part, limited to: o Artificial arms, legs, feet, and hands.
Prosthetic Devices, Wigs, Specialized, Microprocessor or Myoelectric Limbs Page 1 of 21 UnitedHealthcare Commercial Coverage Determination Guideline Effective 01/01/2022 Proprietary Information of UnitedHealthcare.
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