You asked for a summary of the federal provisions referred to in Section 503 of LCO No. 6493, a proposed amendment to SB 24 (Reg. Sess. 2005).

Section 503 of LCO No. 6493 relates to mandatory insurance coverage for prosthetic devices, which means an artificial device to replace, in whole or in part, an arm or a leg. It requires coverage of prosthetic devices that, at a minimum, equals the coverage and payment required by federal laws and regulations for the aged and disabled in 42 USC 1395k, 42 USC 1395l, 42 USC 1395m, 42 CFR 414. 202, 42 CFR 414. 210, 42 CFR 414. 228, and 42 CFR 410. 100, except that coverage cannot be less than $ 300.

The federal laws and regulations referenced are Medicare provisions. Currently, Medicare provides coverage for 80% of the actual charge or the amount recognized as the purchase price for the device, whichever is less. Coverage is subject to the Medicare Part B $ 110 annual deductible. (A recognized purchase price for a device is based on the average local purchase prices for carriers in the region. )

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