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Elevated Vacuum Suspension Systems

Elevated vacuum suspension systems are developed for managing residual limb volume change, minimizing limb movement in the socket, and facilitating perspiration evaporation within the socket.  An elevated vacuum suspension system may include the following components: a total surface bearing socket, a gel liner and a vacuum pump. 

Coverage decision: Covered with conditions (Effective date: March 1, 2014).

Authorization requirements


Is authorization required?

How do I get pre-authorization?

Yes

L&I (State fund):
Complete the Prosthetic Device Request Form and fax to (360) 902-4567

For self-insured: Contact the employer or its third party administrator

 

References

Regulatory authority and related information

 

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