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Reimbursement for facial prostheses or services is based on the type of product being supplied. Use the relevant PIN on all applications and invoices.
Prosthetic devices may be replaced:
| PIN | Description | Maximum reimbursement |
|---|---|---|
| 77123177 | ear prosthesis (left) | $6,500 |
| 77123189 | ear prosthesis (right) | $6,500 |
| 77123501 | nose prosthesis | $6,500 |
| 77123153 | ocular prosthesis (left) | $3,000; or $3,100 (extra fitting required) |
| 77123141 | ocular prosthesis (right) | $3,000; or $3,100 (extra fitting required) |
| 77123165 | Ocular polishing/repairs – use ONLY if no pre-approval is required | Maximum $399.99 |
| 77123531 | Ocular polishing/repairs – use if pre‑approval is required | By approval |