Prosthetic Devices Clause Samples

Prosthetic Devices. This Contract provides benefits, when Medically Necessary, for Prosthetic Devices designed to restore bodily function or replace a physical portion of the body. Coverage for Prosthetic Devices is limited to artificial limbs, artificial joints, ocular prostheses, and cochlear implants. Coverage includes the initial purchase, fitting or adjustment. Replacement is covered only when Medically Necessary due to a change in bodily configuration. The initial Prosthetic Device following a covered mastectomy is also covered. Replacement of intraocular lenses is covered only if there is a change in prescription that cannot be accommodated by eyeglasses. All other Prosthetic Devices are not covered, including Prosthetic Devices for Deluxe, Myo-electric and electronic Prosthetic Devices. The determination of whether a covered item will be paid under the DME, orthotics or prosthetics benefits will be based upon its classification as defined by the Centers for Medicare and Medicaid Services.

Prosthetic Devices. Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions, and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: • Breast prostheses when required because of mastectomy and prophylactic mastectomy • Artificial limbs • Prosthetic eye • Prosthodontic appliances • Penile prosthesis • Joint replacements‌ • Heart pacemakers • Tracheostomy tubes and cochlear implants

Prosthetic Devices. Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: · Breast prostheses when required because of mastectomy and prophylactic mastectomy o Prosthetics related to other Medically Necessary services for Gender Confirmatory therapy and Gender Affirming care are Covered · Artificial limbs · Prosthetic eye · Prosthodontic appliances · Penile prosthesis · Joint replacements · Heart pacemakers · Tracheostomy tubes and cochlear implants

Prosthetic Devices. This Contract provides benefits, when Medically Necessary, for Prosthetic Devices designed to restore bodily function or replace a physical portion of the body. Coverage for Prosthetic Devices is limited to artificial limbs, artificial joints, and ocular prostheses. Coverage includes the initial purchase, fitting, or adjustment. Replacement is covered only when Medically Necessary due to a change in bodily configuration. The initial Prosthetic Device following a covered mastectomy is also covered. Replacement of intraocular lenses is covered only if there is a change in prescription that cannot be accommodated by eyeglasses. All other Prosthetic Devices are not covered, including Prosthetic Devices for Deluxe, Myo-electric and electronic Prosthetic Devices. The determination of whether a covered item will be paid under the DME, orthotics or prosthetics benefits will be based upon its classification as defined by the Centers for Medicare and Medicaid Services.

Prosthetic Devices. The following Prosthetic Devices may be covered when prescribed by a Physician and designed and fitted by a Prosthetist:

Prosthetic Devices. When using a network provider, eighty percent (80%) of charges. When using a non-network provider, sixty percent (60%) of UCR/Allowed Amount. Deductibles apply. One hundred percent (100%) coverage after OPM is reached. Initial device and medically necessary replacements.

Prosthetic Devices. Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Cost-sharing requirements are not more restrictive than the cost-sharing requirements applicable to this plan's medical and surgical benefits, including those for internal devices. Examples of Prosthetic Devices include, but are not limited to: • Breast prostheses when required because of mastectomy and prophylactic mastectomy o Prosthetics related to other Medically Necessary services for Gender Confirmatory therapy and Gender Affirming care are Covered • Artificial limbs • Prosthetic eye • Prosthodontic appliances • Penile prosthesis • Joint replacements • Heart pacemakers • Tracheostomy tubes and cochlear implants

Prosthetic Devices. This agreement provides coverage per Rhode Island General Law. We will cover the following prosthetic devices subject to our guidelines: • Prosthetic appliances such as artificial limbs, breasts, larynxes and eyes, including the replacement or adjustment of these appliances (replacement of a covered device will be allowed only if there is a change in your medical condition or if the device is not functional, no longer under warranty and cannot be repaired); • Devices, accessories, batteries and supplies necessary for attachment to and operation of prosthetic devices; • Orthopedic braces (except corrective shoes and orthotic devices used in connection with footwear); and • Initial and subsequent prosthetic devices following a mastectomy and following an order of a physician or surgeon. This agreement provides benefits for mastectomy-related prosthetics in accordance with the Women’s Health and Cancer Rights Act of 1998 and Rhode Island General Laws 27-20-29 et seq. See Section 3.33 -Surgery Services – Mastectomy.

Prosthetic Devices. External prosthetic devices that replace a limb or a body part, limited to: • Artificial arms, legs, feet and hands. • Artificial face, eyes, ears and nose.