| Coverage Decisions for Medical Technologies & Procedures |  | |
Microprocessor-controlled prosthetic knees
Coverage decision
L&I does not cover microprocessor-controlled prosthetic knees. The small number of studies on computerized knee prostheses does not conclusively show the devices' effectiveness for:
- Reducing energy expenditure.
- Improving ability to walk on uneven ground.
- Improving ability to climb and descend stairs.
- Increasing walking distance.
Microprocessor-controlled prosthetic knees for above-the-knee amputees use computers to enhance basic mechanical knee designs. Sensors incorporated into the prosthesis gather data to determine stance phase and swing phase control. As a result, the prosthesis facilitates amputee response to changing conditions while ambulating.
Are there exceptions to the non-coverage policy?
The Insurer may authorize purchase of a microprocessor-controlled knee prosthesis for the following exception.
A. The patient’s documented need for the computerized prosthesis relates to maintaining or enhancing work-related functions.
i. The patient may require greater ability to ambulate long distances (over 400 yards) at variable rates on a daily basis at work. Use of the limb at home or for basic community ambulation does not justify provision of the computerized limb over standard applications.
OR
ii. The patient may require greater ability to ambulate on uneven ground or on stairs at work. Use of the limb for limited stair climbing in the home or basic community does not justify provision of the computerized limb over standard applications.
AND
B. The patient has previously mastered the use of an advanced stance and swing control hydraulic unit (such as the Mauch, CaTech, or 3R80) as demonstrated by the ability to ambulate at a faster than baseline rate.
AND
C. The patient is a unilateral, transfemoral amputee weighing up to 220 pounds and has a moderate or higher functional level. In addition, the patient has an adequate cardiovascular reserve to allow for faster than normal walking speed.
Supporting Documentation
Microprocessor-controlled prosthetic knees technology assessment (37 KB PDF)
Microprocessor-controlled prosthetic knees references (9 KB PDF).
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