MedicaidCoverageMedium impact
Prosthetics - MEDICAID - VIRGINIA (Revised)
Humana·VA · Orthopedics, Plastic Surgery, Ophthalmology +2 more·Medicaid
Effective date
Feb 11, 2026
We identified it
Jun 24, 2026
Summary
This is a comprehensive revised policy for prosthetics coverage under Virginia Medicaid, covering various prosthetic devices including upper limb prostheses, lower limb prostheses, facial prostheses, and artificial corneas. The policy establishes detailed coverage criteria and introduces new coverage for osseointegrated prostheses for rehabilitation of amputees (OPRA).
Action Required
Before February 11, 2026: Billing team must review and update prosthetics billing procedures for Virginia Medicaid members to ensure compliance with revised coverage criteria. Update billing system with new OPRA coverage requirements including age restrictions (22-65 years), specific medical criteria, and contraindications. Train staff on enhanced documentation requirements for prosthetic devices to meet ADL restoration standards.