Managing Cancer Care

Prostheses (Prosthetics)

In cancer care, implants and prostheses (also known as prosthetics) play a crucial role in helping people recover and maintain their quality of life.

What is a prosthesis?

A prosthesis is the general term for a device, implant, or other item that replaces a body part or function. This can also include other items like ostomy supplies, catheters, and even wigs.

Other terms to know:

  • The plural of prosthesis is prostheses.
  • You might also hear these called prosthetics.
  • Prostheses that are surgically placed inside the body are known as implants.

Why do some people with cancer get a prosthesis?

Sometimes, a person gets a prosthesis because a part of their body is removed to treat or prevent cancer. A person might also get a prosthesis when a body part is still there but doesn’t look or function the same way as it did before.

Surgeries for cancer treatment

Many types of cancer surgery require removing one or more parts of the body because cancer is there. Some examples include:

  • Mastectomy (one or both breasts)
  • Prostatectomy (all or part of the prostate)
  • Laryngectomy (all or part of the larynx — voice box)

Surgeries for cancer prevention

Some people choose to proactively have a body part removed to prevent cancer from developing. For example, someone who is very high risk for breast cancer might choose to have a prophylacticdouble mastectomy (to preventatively remove both breasts).

Certain side effects of cancer treatment

Side effects like hair loss (alopecia) can be especially traumatic for many people. Wigs and other hair pieces are sometimes called cranial prostheses.

People often choose to get prostheses to help them function better, physically or emotionally.  Many people find that a good prosthesis helps with both.

Does insurance cover prosthetics for cancer?

Many insurance plans cover some or all of the cost of a prosthesis.

The Affordable Care Act (ACA) requires all small group insurance plans to cover essential benefits, including prosthetics. But in reality, insurance coverage varies depending on what insurance plan you have and what prostheses you need.

If and how much of the cost is actually covered often depends on whether or not the prosthesis is considered “medically necessary.” There isn’t a standard definition of what is medically necessary, so coverage varies among insurance providers.

Medicare Part B

Most prosthetics that replace a body part or function are covered under Medicare Part B as Durable Medical Equipment (DME). However, if they aren’t considered medically necessary, they might not be covered. (For example, Medicare doesn’t consider cranial prostheses (wigs) for hair loss to be medically necessary.)

Prostheses related to a mastectomy

Prostheses related to a mastectomy are required to be covered by commercial insurance under the Women’s Health and Cancer Rights Act. This includes people who have prophylactic mastectomies to prevent cancer.

Maximizing insurance coverage for your prosthesis

If you are looking into insurance coverage for a prosthesis, there are a few ways you can increase your chances of being approved and getting the maximum benefit possible.

Talk to an insurance representative beforehand

It's a good idea to talk to someone at your insurance company before you get your prosthesis. Knowing certain information ahead of time can speed up the process and help you make the most of your benefits.

Here are some questions to ask your insurance provider:

  • Do you require pre-authorization or pre-approval?
  • What information or documentation do you need for approval?
  • Is there any specific terminology the doctor should include?
  • If approved, how much do you cover?
  • Do you cover a certain number of prostheses or supplies per year or lifetime?
  • Are there any requirements about the type of prosthesis I can get? (For example, Medicare plans only cover prosthetics and supplies from a Medicare-enrolled supplier.)

Check your current policy status

Consider any remaining deductibles, coinsurance, and coverage limitations or caps. These can increase or decrease your final out-of-pocket expenses.

Learn more about managing insurance and cancer-related expenses.

Communicate with a prosthetist

If you’re working with a prosthetist, give them as much information as possible about your insurance coverage. They might be able to recommend certain prosthetics that meet your needs while keeping your out-of-pocket-costs as low as possible.

Types of prostheses

There are many different types of prostheses. Some are worn on the outside of the body and can be put on and taken off (such as a breast form or leg prosthetic). Others are internal and often placed surgically (such as implants in the breast or penis).

Living with a prosthesis

Depending on the type of prosthesis, you might have follow-up care and appointments. It’s important to tell your health care team how you’re doing with your prosthesis. This includes any problems, concerns, or questions you might have.

Sometimes rehabilitation (rehab) or therapy is recommended for people with cancer who are learning to live with a new prosthesis. Rehab and therapy can improve your function, comfort, and  quality of life. Examples are physical therapy, occupational therapy, or speech therapy.

Cancer rehab (or rehabilitation) is another example.

Cancer rehab is a supportive health care program that can help if you have physical or mental side effects caused by cancer or cancer treatment. This includes learning how to do daily activities with your new prosthesis. It also includes learning how to cope with both the physical and emotional effects of living with a prosthesis.

Learn more about cancer rehab.

Written by
References

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.

Centers for Medicare and Medicaid Services. Medicare Coverage of Durable Medical Equipment & Other Devices. U.S. Department of Health & Human Services. January 2024. Accessed August 8, 2024. https://www.medicare.gov/media/publication/11045-medicare-coverage-of-dme-and-other-devices.pdf

Filis P,  Varvarousis D, Ntritsos G, et al. Prosthetic reconstruction following resection of lower extremity bone neoplasms: A systematic review and meta-analysis. J Bone Oncol.36(100452):1-9. Accessed August 9, 2024.doi.org/10.1016/j.jbo.2022.100452

Haddad RI & Limaye S. Overview of approach to long-term survivors of head and neck cancer. In: UpToDate, Nekhlyudov, L (Ed), Wolters Kluwer. Accessed August 8, 2024.

Medicare.gov. Prosthetic Devices. Medicare.gov. Accessed August 2, 2024. https://www.medicare.gov/coverage/prosthetic-devices

Quadri MFA, Alamir AWH, John T, Nayeem M, Jessani A, Tadakamadla SK. Effect of prosthetic rehabilitation on oral health-related quality of life of patients with head and neck cancer: a systematic review. Transl Cancer Res. 2020;9(4):3107-3118. doi:10.21037/tcr.2019.12.48.

Last Revised: August 30, 2024

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