All PlansCoverageMedium impact
Powered and Microprocessor-Controlled Knee and Ankle-Foot Prostheses and Microprocessor-Controlled Knee-Ankle-Foot Orthoses
Regence BlueShield·PM&R (Physical Medicine & Rehab), Orthopedics, General Surgery·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 16, 2026
Summary
New medical policy establishes coverage criteria for microprocessor-controlled prosthetic knees, requiring specific functional levels (K2-K4), cardiovascular reserve, and documented need for variable-rate ambulation or complex job tasks. Powered knees and microprocessor-controlled ankle-foot devices are deemed investigational and not covered.
Action Required
Before April 1, 2026: Billing team must update prior authorization requirements for microprocessor-controlled prosthetic knee requests. Ensure documentation includes Medicare Functional Level (K2-K4), cardiovascular/pulmonary assessment, job task requirements, amputation type, wound status, and cognitive ability evaluation. Create checklist for providers to document specific criteria. Claims without complete documentation will be denied.