On September 1, Medicare expanded its coverage of microprocessor knees (MPKs) to include K2-level amputees.
This isn’t just a win for K2 ambulators, who make up a large segment of the lower-limb amputee population. It’s also a triumph for the principle that advanced prosthetic technology should be available to as many people as possible.
Like any major change in Medicare policy, this one is accompanied by tons of fine print and bureaucratic details. We plowed through it and flagged a handful of key things you should know before you file a claim for your own MPK. For more coverage, see our FAQ page.
Not all K2 Ambulators Are Covered
To qualify, you have to establish that an MPK will diminish your risk of falls, increase your mobility, support an independent lifestyle, and improve your overall health.
You Have to Document How an MPK Knee Would Improve Your Health
All members of your care team can contribute to this documentation, including your prosthetist, surgeon, primary care provider, physical therapist, and other specialists.
You Have to Document Why Basic (non-MPK) Knees Don’t Meet Your Needs
To gain approval, a coverage claim must document that “lower-level knee systems have been considered and ruled out based on the beneficiary’s specific functional and medical needs.”
The Policy Change Does Not Include a “Fail-first” Provision
Even if you’ve spent years walking on a basic knee, you can get covered for an MPK if your care team can show the advanced device will make you more mobile, safer, and healthier.
MPKs From All Manufacturers Are Immediately Covered Under This Policy
No additional trials, clinical studies, or other hurdles have to be cleared. The policy applies to all MPKs that are commercially available.
