A microprocessor-controlled knee may be considered medically necessary in individuals with transfemoral amputation who meet the following requirements:
demonstrated need for long distance ambulation at variable rates (use of the limb in the home or for basic community ambulation is not sufficient to justify provision of the computerized limb over standard limb applications) OR demonstrated patient need for regular ambulation on uneven terrain or for regular use on stairs (use of the limb for limited stair climbing in the home or employment environment is not sufficient evidence for prescription of this device over standard prosthetic application); AND
physical ability, including adequate cardiovascular and pulmonary reserve, for ambulation at faster than normal walking speed; AND
adequate cognitive ability to master use and care requirements for the technology.
A microprocessor-controlled knee is considered investigational in individuals who do not meet these criteria.
A powered knee is considered investigational.
A microprocessor-controlled or powered ankle-foot is considered investigational.
