Where do I start?
Your medical provider may recommend or order a prosthetic for you. Your medical provider can directly contact a prosthetics provider, or they can give you a prescription and you can contact a prosthetic provider of your choice.
The prosthetics provider needs a prescription or detailed written order for the purchase of prosthetic equipment signed by a licensed physician or an independent nurse practitioner. In some cases, a prosthetic provider might need to follow up with your medical provider to get a corrected or more complete document.
Prior authorization
Many prosthetic items require prior authorization (PA). This means MassHealth will determine if the item is medically necessary.
The prosthetic provider will let you know if a PA is needed. If MassHealth denies your PA, we’ll send you a letter of denial to the address that we have on file for you. The letter will include instructions for how to appeal the decision.
Delivery of prosthetic equipment
The prosthetic provider will coordinate delivery of your prosthetic after they get all needed documentation or PA for the item.
Repair or replacement of prosthetic equipment
Contact your prosthetic provider if you need repairs for any prosthetic that MassHealth covers for you.
MassHealth covers replacement prosthetics when the existing equipment no longer meets your medical needs, or if the repairs cost more than replacing the item.
What types of PRT does MassHealth cover?
MassHealth covers prosthetics that are used as an artificial replacement.
MassHealth may cover these prosthetics:
- Above-elbow double-molded wall socket
- All lower-extremity prosthesis shoulder harness
- Ankle Syme molded socket
- Below-elbow molded socket
- Breast prosthetics
- Custom shape protective cover above and below knee
- Custom shape protective cover below and above knee
- Hand restoration
- Interscapular thoracic passive restoration
- Knee disarticulation molded socket
- Partial foot shoe insert
- Partial hand
- Preparatory wrist disarticulation or below elbow
- Prosthetic donning sleeve
- Prosthetic sheath below and above knee and upper limb
- Prosthetic shrinker below and above knee
- Prosthetic sock below and above knee
- Repair of prosthetic device
- Replacement socket below knee
- Replacement socket below elbow/wrist disarticulation molded to patient model
- Shoulder disarticulation passive restoration
- Upper-extremity addition flexion/extension and rotation wrist unit
MassHealth may also cover other prosthetics. Talk to your medical provider if you need an item you don't see on this list.
MassHealth doesn’t cover any prosthetic services that aren’t medically necessary and aren’t reasonable for the treatment of your condition. This includes services that
- won’t significantly help your condition or how you perform your activities of daily living;
- cost more than a medically similar and suitable alternative or that serve a similar purpose as equipment already available to you; or
- are nonmedical prosthetic services. This is equipment that’s usually used primarily for a nonmedical purpose. This isn’t considered medical equipment, even if that equipment has a medically related use.
Who do I contact if I need help?
MassHealth Customer Service Center
Contact the MassHealth Member Customer Service Center if you need help with:
- Eligibility
- MassHealth benefits
- Replacing your MassHealth card
- Enrolling in a health plan
- Getting a MassHealth application
- MassHealth and Children's Medical Security Plan premiums
Phone: (800) 841-2900, TDD/TTY: 711
My Ombudsman
My Ombudsman can assist any MassHealth member with questions or challenges accessing covered benefits or services.
Phone: (855) 781-9898
Videophone: (339) 224-6831
Email: info@myombudsman.org
My Ombudsman website
| Date published: | December 8, 2025 |
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