On September 1, Medicare will expand its coverage of microprocessor knees (MPKs) to include K2 amputees.
When the proposal was announced back in February, we didn’t expect the change to take effect until the end of 2024 at the earliest. But for whatever reason, this particular idea whisked through the bureaucracy in less than six months, which is lightning speed as these things go. So much the better for the many thousands of amputees who will be able to obtain MPKs under the new policy.
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.
Where you’re just learning about this policy change or have been tracking its progress through the Medicare maze, you’re bound to have questions. Here’s a rundown of the details, presented in a handy Q+A format. If you’re a glutton for punishment, you can review the specific policy language at cms.gov. To read public comments on the policy (many of them submitted by amputees) and responses from the Centers on Medicare and Medicaid Services (CMS), follow this link.
What’s changing?
Under the expiring policy, Medicare only covers MPKs for amputees at levels K3 and K4, ie advanced ambulators. The new policy will add coverage for many (not all) amputees at level K2, defined as “limited community ambulators.”
Why did this change get approved?
In a word: money. The old policy was based on the premise that only the highest-functioning ambulators could benefit from an MPK’s advanced features. But numerous studies in the last decade have shown that K2 ambulators derive significant benefits from MPKs, including better balance, gait stability, confidence, and quality of life. Above all, MPKs have tremendous fall-prevention capacity—and since K2 ambulators are highly prone to injurious falls, MPKs confer huge health and safety gains in that population. All these benefits are projected to produce massive cost savings for Medicare: By covering advanced prosthetics on the front end, the system will cultivate a more mobile K2 population with fewer routine healthcare needs, less frequent hospitalizations after falls, and less costly Medicare claims overall.
Will all K2 ambulators be covered for MPKs under the new rule?
No. To qualify for coverage, you have to submit documentation establishing that an MPK will diminish your risk of falls, increase your mobility, help you conduct activities of daily living independently, and improve your overall health. This documentation can be provided by any and all members of your care team, including prosthetists, surgeons, primary care providers, physical therapists, occupational therapists, and other specialists.
Exactly what type of documentation will need to be produced?
The policy specifies that documentation must address the following issues (at minimum):
- Which functional health outcomes (e.g., fall reduction, injury prevention, lower energy expenditure) are expected to be improved with the selected knee, and
- Which activities of daily living (e.g., transferring, climbing stairs, grocery shopping, housekeeping, working) are expected to be improved with the use of the selected knee
- Which less advanced knees were considered but ruled out, and why the less advanced knee fails to meet the individual’s needs
Do I need to get a new K-level evaluation to qualify for this?
No, that part of the system is unchanged. If you were assessed as a K2 ambulator before, you’re still a K2 ambulator today. Prosthetists will continue to make K-level determinations under the same criteria as before.
Do MPK manufacturers have to gain approval from Medicare before their products will be covered for K2 ambulators?
No. All MPKs that have received FDA approval and are currently available to K4 and K3 patients will immediately, automatically be covered for K2 amputees when the new Medicare rule takes effect on September 1.