Prosthetic K-Level Diagnosis

Prosthetic K-Levels are defined by Medicare based on an individual’s ability or potential to ambulate and navigate their environment. Once it is determined by their physician, in which K-level an individual resides, it can then be determined which prosthetic components are covered by Medicare.  It is important to re-emphasise that a medical doctor (treating physician) must make this determination.  Please see K-Level descriptions below for more details.  For your convenience, a K-Level Checklist (pdf) is provided below, which can be printed out and given to your doctor for further discussion regarding your condition.

K-Level

Description

K0

This patient does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.

K1

This patient has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence – a typical limited or unlimited household ambulator.

K2

This patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces – a typical community ambulator.

K3

The patient has the ability or potential for ambulation with variable cadence – a typical community ambulator with 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 – typical of the prosthetic demands of the child, active adult, or athlete.

Prosthetic K-Level Diagnosis

Prosthetic K-Level Diagnosis

** In an effort to be compliant with insurance regulations, we are required to have in our notes the physician’s evaluation of the amputee patient.  The doctor’s evaluation MUST indicate the appropriate K-Level above (potential is the key word. Patient may currently be a K-Level 2, but has the ability to be a K3).  Doctor’s notes should detail when and why they have seen the patient and what his expectations are.  Some suggestions might be; with the prosthesis, patient will be ambulatory, able to exercise, drive, climb stairs, mow lawn, shop, cook, be independent.

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