MVP Health prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
MVP Health covers custom prosthetics and orthotics—and Orthotics Ltd manages the entire insurance process from start to finish. Prescriptions. Prior authorization. Claims. We take care of it so you can focus on getting back on your feet.
What MVP Health covers
Prosthetic devices
MVP Health covers medically necessary prosthetic devices, including:
- Lower limb prosthetics (below knee, above knee, partial foot, hip disarticulation)
- Upper limb prosthetics (below elbow, above elbow, partial hand, shoulder disarticulation)
- Pediatric prosthetics (with coverage for growth-related replacements)
- Bionic and myoelectric prosthetics (when medically necessary)
- Prosthetic socket replacements and adjustments
- Cosmetic covers and sleeves
Orthotic devices
MVP Health covers custom orthotic devices, including:
- Custom braces (ankle, knee, wrist, elbow, back, neck)
- Compression garments
- Spinal orthotics
- Custom-molded shoes and inserts
- Orthotic repairs and adjustments
Additional covered services
- Initial consultation and evaluation
- Custom fitting and adjustments
- Follow-up care and modifications
- Repairs and replacements (when medically necessary)
How MVP Health coverage works
Understanding MVP Health plan types
MVP Health Care offers multiple plan types in New York:
- MVP Medicaid (New York Medicaid managed care)
- MVP Medicare (Medicare Advantage plans)
- MVP Commercial plans (employer-sponsored)
- MVP Individual & Family Plans (marketplace)
- Child Health Plus
Coverage and cost-sharing vary by plan type. We’ll verify your specific benefits.
01
Get a prescription
Your physician provides a prescription for the prosthetic or orthotic device. We can help coordinate with your doctor's office if needed.
02
We verify your benefits
We contact MVP Health to verify your coverage and confirm what you'll owe out-of-pocket based on your plan type.
03
We submit prior authorization
MVP Health requires prior authorization for prosthetics and orthotics. We handle all documentation and follow up with MVP's review team.
04
We create your custom device
Once approved, we scan or cast your limb, create a test socket or device, and work with you until the fit is perfect.
05
We bill MVP Health directly
After delivery, we submit claims directly to MVP Health. You'll receive an Explanation of Benefits showing what MVP paid and any remaining balance.
What you'll pay with MVP Health
Medicaid members
If you have MVP through New York Medicaid, prosthetics and orthotics are covered with no copays, deductibles, or out-of-pocket costs.
Medicare Advantage members
MVP Medicare members pay according to Medicare Part B guidelines:
Medicare Part B deductible (if not yet met)
20% coinsurance after deductible
Some MVP Medicare plans offer enhanced benefits with lower cost-sharing.
Commercial and marketplace plan members
Cost-sharing depends on your specific plan:
- Deductible (if not yet met)
- Copay or coinsurance per item
- Out-of-pocket maximum
We tell you what to expect upfront
Before we begin fabrication, we'll provide a clear estimate of your financial responsibility. No surprises.
Why Orthotics Ltd makes MVP Health coverage easy
We verify benefits before you commit
You'll know exactly what MVP Health covers and what you'll owe before we start creating your device.
We handle all prior authorizations
We submit all documentation to MVP Health and follow up until authorization is approved.
We bill MVP Health directly
You don't submit claims. We handle all billing and follow up with MVP on your behalf.
We work with your doctor
We coordinate with your physician's office to ensure we have all necessary prescriptions and medical documentation.
We serve upstate and downstate New York
MVP Health serves communities throughout New York. We work with patients across the state.
Helpful MVP Health resources
Log in to check your benefits, view claims, and access your health information.
Search for in-network providers (Orthotics Ltd is in-network with MVP Health).
Contact MVP with questions about your plan or benefits. Customer Service: 1-800-777-4793
Information for Medicaid members.
Common questions about MVP Health coverage
Does MVP Health cover prosthetics and orthotics?
Yes. MVP Health covers medically necessary prosthetic and orthotic devices across all plan types.
Do I need a referral?
It depends on your plan type. MVP HMO plans typically require referrals; PPO plans often do not. We’ll verify this when we check your benefits.
How long does MVP Health authorization take?
Prior authorization typically takes 5-10 business days. We follow up with MVP throughout the process.
Does MVP Health cover pediatric prosthetics?
Yes. MVP Health covers pediatric prosthetics through Child Health Plus and other plans, with coverage for growth-related replacements.
What if my prosthetic needs repairs?
MVP Health covers medically necessary repairs and adjustments.
Does MVP Health cover bionic or myoelectric prosthetics?
Yes, when medically necessary and prescribed by your physician.
I have Medicaid through MVP. Will I owe anything?
Most Medicaid members have no out-of-pocket costs for medically necessary prosthetics and orthotics.
Locations serving MVP Health members
Orthotics Ltd serves MVP Health members throughout New York.
Our clinic:
Harriman, NY
We also offer:
- Home visits for patients who can’t travel
- Nursing home partnerships
- Emergency prosthetic services
Ready to use your MVP Health benefits?
