Section 17-1737-74 - Prosthetic and orthotic appliances(a) Prosthetic and orthotic appliances means those appliances prescribed by a physician, dentist, or podiatrist for the restoration of function or replacement of functional body parts.(b) Prior authorization shall be required when the original or cumulative cost for purchase, repair, or manufacture of the appliances exceeds $50, except for dental prosthetic appliances which are covered under section 17-1737-75.(c) The following items may be covered by the medical assistance program: (1) Stock prosthetic eyes to prevent the problems associated with an empty eye socket;(2) Orthopedic and therapeutic shoes when prescribed by a physician and provided by a prosthetist or an orthotist and when at least one of the shoes will be attached to a brace or prosthesis or the individual is diabetic;(3) Stock orthopedic shoes and high-topped shoes for children under the age of six years;(4) Modification of stock conventional or orthopedic shoes when medically necessary;(5) Custom-made orthopedic shoes when there is a clearly established medical need that cannot be satisfied by the modification of stock conventional or orthopedic shoes; and(6) Implanted breast prosthesis provided the surgical procedure of implantation is approved by the department.(d) Testicular prosthesis shall not be included in the medical assistance program.Haw. Code R. § 17-1737-74
[Eff 08/01/94; am 09/17/07 ] (Auth: HRS § 346-14) (Imp: 42 C.F.R. §§440.120 )