Prescriptions for Custom Silicone Prostheses
A signed and dated physician's prescription is required for all prosthetic care, even if insurance funding will not be utilized. Prescriptions and user demographics can be faxed to our clinic at (919) 251-9275.
Medical Necessity Documentation for Silicone Partial Foot Prostheses
Most insurance companies, including Medicare, will consider a functional silicone prosthesis medically necessary if there is adequate supporting documentation in the physician and provider notes. Examples might include the need for:
Documentation should also identify the potential prosthetic user's functional ambulation level, which is also referred to as K-level. The four K-levels are:
K0:
No potential or desire to use a prosthesis (insurance will not cover a prosthesis for a user at this activity level.
K1:
The patient has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. This is typical of a household ambulator or a person who only walks about in their own home.
K2
The patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs or uneven surfaces. This is typical of the limited community ambulator.
K3
The patient has the ability or potential for ambulation with variable cadence. A person at level 3 is typically a community ambulator who also has the ability to traverse most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic use beyond simple locomotion.
K4
The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. This is typical of the prosthetic demands of the child, active adult or athlete.
Medicare does not cover high realism finishing of a silicone partial foot prosthesis. If attempting to obtain funding for high realism finishing via another funding source, documentation of the user's emotional needs, and the impact high realism will have on the person's overall wellbeing, should be well documented.
Contact us at info@functionalrestorations or call (919) 802-8020 to learn more.
- Increased support through the arch for improved alignment and energy return
- Total contact silicone suction design to offer stability, reduce friction, and restore proprioception
- Maximize shock absorption and cushion, to protect the residuum
- Ankle support in all planes, to combat instability and meet functional needs
- Anatomical restoration
Documentation should also identify the potential prosthetic user's functional ambulation level, which is also referred to as K-level. The four K-levels are:
K0:
No potential or desire to use a prosthesis (insurance will not cover a prosthesis for a user at this activity level.
K1:
The patient has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. This is typical of a household ambulator or a person who only walks about in their own home.
K2
The patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs or uneven surfaces. This is typical of the limited community ambulator.
K3
The patient has the ability or potential for ambulation with variable cadence. A person at level 3 is typically a community ambulator who also has the ability to traverse most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic use beyond simple locomotion.
K4
The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. This is typical of the prosthetic demands of the child, active adult or athlete.
Medicare does not cover high realism finishing of a silicone partial foot prosthesis. If attempting to obtain funding for high realism finishing via another funding source, documentation of the user's emotional needs, and the impact high realism will have on the person's overall wellbeing, should be well documented.
Contact us at info@functionalrestorations or call (919) 802-8020 to learn more.
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Functional Restorations LLC offers custom silicone and 3D printed prosthetic restoration to individuals with anatomical loss, or deficiency, of the hands, feet, breast, and face. With decades of experience, we combine digital design, orthopedic know-how, and anaplastology to create each prosthesis we design. 1200 Broad Street, Suite 108 Durham, NC 27705 By Appointment Only Phone: (919) 802-8020 Fax: (919) 251-9275 [email protected] All images copyright 2023 Functional Restorations |