Does Medicare Cover Eye Prostheses?

All eye prostheses for patients with shrinkage or absence of one or both eyes due to a birth defect, eye trauma or surgical removal are covered under Medicare Part B.

There are some restrictions that apply to coverage. They include:

• Polishing and resurfacing are covered twice every 12 months.
• Replacements of eye prostheses are covered every five years.
• Replacements needed in less than five years are only covered if the eye prostheses are irreparably damaged, lost, or stolen.
• Enlargements or reductions of the prostheses are covered once without documentation.
• Additional enlargements or reductions are only covered when medically necessary.
• The order for the prostheses must be kept on file with the supplier in the event it needs to be made available to the DMERC.

How Much Do You Pay?

You pay for 20% of the Medicare-approved amount under Medicare Part B.

You must pay your deductible for any Medicare Part B services and supplies before Medicare begins to pay its share. If a doctor, health care provider or supplier does not accept assignment, the amount you pay may be higher. It is extremely important that your supplier is a participating supplier in the Medicare Program. If a supplier of your durable medical equipment (DME) does not accept assignment there is no limit to what you can be charged. You may also have to pay the entire bill (including Medicare's share) at the time you get your Durable Medical Equipment (DME) Medicare Administrator Contractor (MAC).