New Medicare Coverage for Advanced Prosthetics, Orthotics, and Power Wheelchairs (On Demand)-New Medicare Coverage for Advanced Prosthetics, Orthotics, and Power Wheelchairs

Video Transcription

Video Summary

The webinar provided information on recent advances in coverage and coding for orthotics and prosthetics, primarily focusing on Medicare patients. Dr. Prateek Grover, a specialist in rehabilitation medicine, and Peter Thomas, a legal expert, discussed several developments. The webinar began with an overview of Medicare’s policy changes, notably expanding coverage for microprocessor-controlled knees to include K2 amputees—limited community ambulators. This decision came after years of advocacy, addressing issues of limited mobility and fall risks among this group.<br /><br />Thomas detailed the updated requirements for documenting medical necessity for these devices, emphasizing the need for clear evidence in medical records. He also highlighted progress in other areas, such as upper limb prosthetics coding, bone-anchored prostheses (osseointegration), and powered orthoses. These advancements represent significant strides in facilitating access to modern technologies for individuals with limb loss.<br /><br />Dr. Grover discussed the importance of documenting patients' functions before limb loss, current conditions, and anticipated abilities with prosthetic devices. This thorough assessment aids in determining appropriate rehabilitation plans and prosthetic prescriptions, ensuring they meet patients' personal and work needs.<br /><br />Furthermore, recent policies have also led to the coverage of seat elevation features in powered wheelchairs and introduced new codes for hydrophilic catheters, enhancing usability and reducing infection risks. The session concluded with questions from the attendees about practical challenges in insurance and therapy provisions, reflecting ongoing efforts to ensure health care access aligns with patients’ clinical needs.

Keywords

orthotics

prosthetics

Medicare

microprocessor-controlled knees

K2 amputees

osseointegration

powered orthoses

rehabilitation

prosthetic prescriptions

insurance challenges