Prosthetics

The Department requires that prosthetic services be provided by a licensed occupational therapist, a licensed physical therapist, certified orthotist or prosthetist (American Board for Certification) or an accredited orthotist (Board for Orthotist Certification) when an orthotic or prosthetic device is prior authorized.

A prosthetic device is defined as an artificial substitute for a missing body part (i.e., arm, leg, eye), not including dentures.

PA is required for all prosthetics. The amount paid for orthotics and prosthetics shall be 94% of the lowest of:

1. The maximum Maine Care amount published at least annually on the Department's website and made available to providers;
2. The lowest amount paid by Medicare;
3. The provider’s usual and customary charge; or
4. The manufacturer’s suggested retail price (including replacement parts).

Members who meet the eligibility requirements for both a prosthetic device necessary to allow functional mobility and a wheelchair must choose between the prosthetic device and a wheelchair and must sign a letter exercising their choice. A wheelchair will be provided in the interim on a rental basis for those members choosing a prosthetic device. Members may seek prior authorization for a manual wheelchair in addition to a prosthesis if medically necessary.

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