The short answer
CHAMPVA covers medically necessary prosthetics, like artificial limbs, eyes, and voice prostheses, and orthotic braces for the neck, arm, back, and leg. Orthopedic shoes, arch supports, and shoe inserts generally aren't covered, except shoes built into a brace and diabetic shoes with inserts. You pay your deductible and 25%.
Prosthetics
38 CFR 17.272(a)(42) covers non-dental prostheses that are medically necessary because of a significant condition from trauma, a birth defect, or disease. Examples:
- artificial limbs,
- voice prostheses,
- artificial eyes,
- items surgically implanted as part of a procedure, and
- prosthetic ears, noses, and fingers.
The CHAMPVA Guidebook also lists FDA-approved surgical implants.
Dental prostheses follow separate, narrower rules. More here: CHAMPVA dental coverage.
Braces
The Guidebook covers orthotic braces when appropriate and furnished by an authorized provider, like braces for the neck, arm, back, and leg that support a limb or help movement.
Shoes and inserts
38 CFR 17.272(a)(43) excludes orthopedic shoes, arch supports, shoe inserts, and other foot supports, with two exceptions:
- Shoes that are part of a brace and can't be used without it.
- Diabetic shoes: extra-depth or custom-molded shoes with inserts for people with diabetes.
The Guidebook's yearly limits for diabetic footwear:
- one pair of custom-molded shoes with inserts,
- one pair of extra-depth shoes, and
- three pairs of multi-density inserts.
Custom foot orthotics for plantar fasciitis or flat feet aren't covered, even if custom made.
For more on diabetes coverage, see CHAMPVA diabetes supplies and care.
At a glance
| Item | Covered? |
|---|---|
| Artificial limb | Yes, when medically necessary |
| Neck, arm, back, or leg brace | Yes, when appropriate |
| Shoe built into a brace | Yes |
| Diabetic shoes and inserts | Yes, within yearly limits |
| Regular orthopedic shoes, arch supports, or inserts | No |
How are these priced, and what do you pay?
Under 38 CFR 17.275, CHAMPVA uses Medicare's equipment fee schedule for your area. When CHAMPVA is your only coverage, you pay your yearly deductible, then 25% of the allowable amount. Your family's yearly total stops at $3,000.
Custom items can cost a lot more than CHAMPVA's price. Ask if the supplier accepts CHAMPVA assignment before ordering. More here: CHAMPVA assignment and balance billing.
Do these need preauthorization?
No, but item-specific paperwork can apply. Before anything is made, have the supplier confirm:
- the billing code,
- the diagnosis showing medical necessity,
- which exception applies, for shoes,
- the order and any other required records, and
- whether other insurance pays first.
Before ordering
- Know which category it is: prosthesis, brace, foot support, or diabetic shoe.
- Make sure the medical need is documented.
- Ask about assignment and what you'll owe.
- Keep the order, records, bills, and EOBs.