Does Medicare cover prosthetics?

Yes. Medicare covers prosthetic limbs. Under Original Medicare, artificial limbs are a covered benefit through Part B — specifically under the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) category — when a physician documents that the device is medically necessary to replace a missing limb or restore function. The rules below are general; your plan and situation can change the details, so confirm with your supplier and Medicare before a fitting.

What you pay: the 80/20 split

After you meet your annual Part B deductible, Medicare pays 80% of its approved amount for the prosthesis and you are responsible for the remaining 20% coinsurance. For 2026 the standard Part B deductible is $283. The 20% applies to Medicare’s approved fee-schedule amount, which is not necessarily the same as a supplier’s retail price.

Two things to watch: first, the 20% coinsurance has no built-in cap — on a high-end device it can be substantial, which is why many people carry a Medigap plan that covers it. Second, your supplier should accept Medicare assignment; a supplier who doesn’t can charge above the approved amount, raising your share.

You must use a Medicare-enrolled supplier

Medicare only pays for a prosthesis supplied by a provider enrolled in the program. Quantum is set up to bill Medicare directly. If you go to a non-enrolled supplier, Medicare may pay nothing.

Medical necessity and K-levels

Coverage hinges on documentation. A licensed physician — not the prosthetist alone — must establish medical necessity, and for lower-limb prostheses Medicare uses a functional classification called the K-level (K0–K4) to decide which components are justified. As a rule of thumb, K1 and above can qualify for a lower-limb prosthesis, and higher K-levels unlock more advanced knees and feet. We explain this system in detail in Understanding K-levels.

Prior authorization for advanced knees

Certain high-cost lower-limb items — including microprocessor knees — require prior authorization, and some states require it for additional lower-limb prosthetics. Getting that approval in writing before fitting prevents the most common and most painful surprise: a denied claim after the device is delivered.

Medigap and Medicare Advantage

Most Medigap (Medicare Supplement) plans cover the 20% Part B coinsurance, which can bring your out-of-pocket for a covered prosthesis close to zero after the deductible. Medicare Advantage (Part C) plans must cover at least what Original Medicare covers, but they typically use provider networks and require prior authorization more often — so confirm that your prosthetist is in-network and that the device is pre-approved.

Repairs, replacement, and useful life

Medicare covers repairs due to normal wear and will cover replacement when a device is lost, irreparably damaged, or worn out past its useful life — generally around five years for a prosthesis, though your clinical need governs.

If your claim is denied

Denials are often fixable. Common reasons include missing physician documentation, a K-level that doesn’t match the prescribed component, or a non-enrolled supplier. The Medicare appeals process has five levels; the first, a redetermination, must generally be requested within 120 days of the denial. Read the denial notice carefully — it states the exact reason and your appeal rights — and ask your prosthetist’s billing team for help assembling the documentation.

This is general educational information, not a coverage determination or legal advice. Coverage figures and rules change year to year and by plan. Verify your specifics with Medicare (1-800-MEDICARE) or your plan, or let our team run your benefits before you commit.

Want us to verify your Medicare or Medigap coverage for a specific device? Book a free consultation and we’ll handle the benefits check.