• A prosthetic leg is an artificial limb designed to replace a leg that has been amputated or is missing due to an injury, disease, or congenital conditions.

• The purpose of a prosthetic leg is to replace a missing or amputated leg. A prosthetic leg allows patients to regain mobility and function. It can help patients walk, run, and perform activities more easily, which leads to an improved quality of life. Prosthetic legs are designed to mimic the natural movement of a leg. The goal is to provide comfort, stability, and support while also enhancing independence and participation in social and physical activities.

• There are many factors and steps involved in receiving a prosthetic leg. There are clinical and administrative tasks that must be completed before delivery of the patient’s final prosthesis.
  • Clinical: To begin the process of receiving a prosthesis, a patient must first be evaluated in our office by one of our highly trained and knowledgeable prosthetists. In order to schedule an evaluation appointment, our office must receive a referral or prescription from a medical professional. In certain cases, we may perform a consultation appointment without a referral or prescription, but the patient must then follow up with a medical professional to receive a referral and establish care related to their prosthesis. After we receive the referral, we contact the patient to schedule them for their first appointment. The flow of appointments in our office goes as follows:
    • Initial Consultation
    • Casting
    • Diagnostic Fitting #1
    • Diagnostic Fitting #2
    • Delivery Fitting
    • Follow Up

To see detailed information about the types of appointments and what they entail, please visit our PROSTHETICS page for additional information.

• Administrative: After the patient’s initial consultation appointment, our administrative staff begins to work diligently to obtain all the necessary documentation required by the patient’s insurance company to ensure coverage for their prosthesis. Insurance company requirements and restrictions vary from one insurance to the next, and from one plan to the next. Generally, we will need the following documentation before we can proceed with fabricating the patient’s final prosthesis.
  • Referral or Prescription from a Medical Professional
    • Examples of qualifying referral sources are below:
      • M.D. (Doctor of Medicine)
      • D.O. (Doctor of Osteopathic Medicine)
      • P.A. (Physician Assistant)
      • N.P. (Nurse Practitioner)
  • Clinical Chart Notes/Progress Notes
    • Clinical chart notes must, at minimum, include the following:
      • Amputation details
      • Status of residual limb
      • Current physical condition
      • Activities of Daily Living (ADLs)
      • Activity Level (K-Level)
  • Standard Written Order
    • A Standard Written Order (SWO) is a form that our office will send to the patient’s referring provider. The form will detail each component that we intend on providing with the patient’s prosthesis. The billing codes for each component will be listed, along with detailed justifications as to why we are choosing those components. The referring provider must review the document, sign and date it, and return it to our office in a timely manner. We must receive this document prior to the patient receiving their final prosthesis.
  • Verification of Benefits
    • After the patient is evaluated, and the prosthetist determines which billing codes are appropriate, we verify the patient’s insurance benefits details. We verify if there are any deductible, out-of-pocket, and co-insurance amounts that will be due prior to delivery of their prosthesis. As soon as our administrative staff are aware of this information, they will contact the patient to inform them of this information.
  • Prior Authorization
    • Not all insurance companies require prior authorization, but most do. Due the cost and intricate details involved with providing a prosthesis, most insurance companies will perform a pre-service review to determine if the prosthesis is medically necessary and covered within the patient’s benefit package. Prior authorization requests are submitted by our office in a timely manner. Insurance companies have different timelines for providing us with a response to our requests, but we often receive responses from insurance companies within 5-14 business days.
    • In order to submit to a patient’s insurance for prior authorization, we must include the following documents at minimum in order for them to consider our request:
      • Referral or Prescription from a Qualifying Medical Professional (examples listed above)
      • Clinical Chart Notes/Progress Notes
        • Clinical documentation must be provided by the referring provider and include all necessary components to establish medical necessity for the patient receiving the prosthesis.
        • Supplemental clinical documentation may come from other sources as well. If the patient has multiple providers that they see for their prosthetic needs, our office will work with those providers to gather information from them as well. Examples of providers that may supply us with supplemental information (outside of the referring provider) are listed below:
          • Vascular Surgeons
          • Orthopedic Doctors
          • Podiatrists
          • Primary Care Providers
          • Physical Therapists

• There are a multitude of benefits involved in a patient receiving a prosthetic leg. Our goal is to provide a prosthesis that will change the patient’s life for the better. Examples of benefits of a prosthetic leg are below:
  • Improved Mobility: A prosthetic leg can enhance a patient’s overall mobility, allowing them to walk, run, and engage in daily activities.
  • Improved Quality of Life: With improved mobility, patients can engage in social, professional, and recreational activities, boosting their confidence and overall quality of life.
  • Improved Mental Health: Most patients report that after receiving a prosthetic leg they feel an increase in confidence and lessened feelings of isolation. These factors can have a positive impact on their mental health.
  • Improved Physical Health: Being able utilize a prosthetic leg typically means that a patient has the ability to perform physical activities, improving their overall physical health.
  • Increased Independence: After receiving a prosthetic leg, most patients are able to perform tasks on their own, providing them with greater independence in life.
  • Rehabilitation Support: Once a patient experiences an amputation, it is recommended that they begin a regimen of physical therapy, and sometimes occupational therapy. These therapies are in place to assist them in learning how to navigate their daily lives now that they are missing a limb. To support the patient in receiving optimal results in therapy, having a prosthetic leg to work with is a tremendous help.