 The device is Medically Necessary to restore or maintain the ability to complete activities of daily living or essential job-related activities and that are not solely for comfort or convenience.  The device is required to replace all or part of an organ or extremity designated by CMS in the “L codes” of the Healthcare Common Procedure Coding System. This coverage includes all Services and supplies that are Medically Necessary for the effective use of an External Prosthetic Device or Orthotic Device, including formulating its design, fabrication, material and component selection, measurements, fittings, static and dynamic alignments, and instructing the patient in the use of the device. Internally implanted prosthetic and Orthotic Devices, such as pacemakers, intraocular lenses, cochlear implants, osseointegrated hearing devices, artificial hearts, artificial larynx, and hip joints, are not covered under this “External Prosthetic Devices and Orthotic Devices” benefit, but may be covered if they are implanted during a surgery that we are covering under another section of this “Benefit Details” section. Covered External Prosthetic Devices and Orthotic Devices include but are not limited to:  Compression garments for burns.  Diabetic foot care appliances and therapeutic shoes and inserts to prevent and treat diabetes-related complications.  External prostheses after a Medically Necessary mastectomy, including prostheses when Medically Necessary, and up to four brassieres required to hold a prosthesis every 12 months.  Fitting and adjustments.  Halo vests.  Lymphedema wraps and garments.  Maxillofacial prosthetic devices: coverage is limited to the least costly clinically appropriate treatment as determined by a Participating Provider. We cover maxillofacial prosthetic devices if they are necessary for restoration and management of head and facial structures that cannot be replaced with living tissue and are defective because of disease, trauma, or birth and developmental deformities when this restoration and management are performed for the purpose of: • Controlling or eliminating infection; • Controlling or eliminating pain; or • Restoring facial configuration or functions such as speech, swallowing, or chewing, but not including cosmetic procedures rendered to improve the normal range of conditions.  Ocular prosthesis.  Prosthetic devices for treatment of temporomandibular joint (TMJ) conditions.  Prosthetic devices required to replace all or part of an organ or extremity, but only if they also replace the function of the organ or extremity. This includes but is not limited to ostomy and urological supplies.  Repair or replacement (unless due to loss or misuse).  Rigid and semi-rigid Orthotic Devices required to support or correct a defective body part.  Tracheotomy equipment.  A wig or hairpiece to replace lost hair due to radiation therapy or chemotherapy for a covered condition, up to a lifetime benefit maximum payment of $100 per Member. We periodically update the list of approved Durable Medical Equipment, External Prosthetic Devices and Orthotic Devices to keep pace with changes in medical technology and clinical practice. To find out if a EWCLGDED1983ACT0124 44 WAPEBB-CL-ACT