Medicare Expands Access to Microprocessor Prosthetic Knees

The Centers for Medicare & Medicaid Services (CMS) and the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) medical directors have made major strides over the past year in responding to the needs of O&P Medicare patients, and the providers and manufacturers who serve the population of individuals with limb loss and limb difference. In March 2023, the DME MACs retired coding guidance for upper-extremity prostheses that was linked to major barriers in access to care. Last May, CMS issued a final National Coverage Determination establishing coverage of seat elevation in power wheelchairs, a function that can dramatically assist individuals with limb loss in performing mobility-related activities of daily living in their homes, including reaching objects from their wheelchairs.

In June 2023, CMS proposed and then finalized new regulations that define orthotics to include powered orthoses, a whole new family of orthotic technologies that has incredible potential to assist people with limb loss, paralysis and other disabling conditions in ambulating and performing daily functions. Recently, the DME MAC medical directors announced a new policy for Medicare coverage of a whole new suite of prosthetic knees that will dramatically benefit limited community ambulators (i.e., people deemed K2 under the Medicare Functional Classification Level (MFCL) system) who could not gain access to these technologies for the past three decades.