Page 141 - Medicare Benefit Policy Manual

ASC is included with the payment for facility services that are furnished in connection
with the covered surgery.

Refer to the Medicare Claims Processing Manual, Chapter 14, “Ambulatory Surgical
Centers,” for more information.

3. Limitation on Coverage of Conventional Lenses

One pair of conventional eyeglasses or conventional contact lenses furnished after each
cataract surgery with insertion of an IOL is covered.

C. Dentures

Dentures are excluded from coverage. However, when a denture or a portion of the
denture is an integral part (built-in) of a covered prosthesis (e.g., an obturator to fill an
opening in the palate), it is covered as part of that prosthesis.

D. Supplies, Repairs, Adjustments, and Replacement

Supplies are covered that are necessary for the effective use of a prosthetic device (e.g.,
the batteries needed to operate an artificial larynx). Adjustment of prosthetic devices
required by wear or by a change in the patient’s condition is covered when ordered by a
physician. General provisions relating to the repair and replacement of durable medical
equipment in §110.2 for the repair and replacement of prosthetic devices are applicable.
(See the Medicare Benefit Policy Manual, Chapter 16, “General Exclusions from
Coverage,” §40.4, for payment for devices replaced under a warranty.) Replacement of
conventional eyeglasses or contact lenses furnished in accordance with §120.B.3 is not
covered.

Necessary supplies, adjustments, repairs, and replacements are covered even when the
device had been in use before the user enrolled in Part B of the program, so long as the
device continues to be medically required.

130 - Leg, Arm, Back, and Neck Braces, Trusses, and Artificial Legs,
Arms, and Eyes
(Rev. 1, 10-01-03)
B3-2133, A3-3110.5, HO-228.5, AB-01-06 dated 1/18/01

These appliances are covered under Part B when furnished incident to physicians’
services or on a physician’s order. A brace includes rigid and semi-rigid devices which
are used for the purpose of supporting a weak or deformed body member or restricting or
eliminating motion in a diseased or injured part of the body. Elastic stockings, garter
belts, and similar devices do not come within the scope of the definition of a brace. Back
braces include, but are not limited to, special corsets, e.g., sacroiliac, sacrolumbar,
dorsolumbar corsets, and belts. A terminal device (e.g., hand or hook) is covered under
this provision whether an artificial limb is required by the patient. Stump stockings and