Lower-Limb Prosthetics, Including Microprocessor-Controlled Prosthetics

This policy covers lower‑limb prosthetic devices and services, including microprocessor‑controlled knees (MPKs), for HCSC members residing in Arkansas, addressing everyday and recreational prostheses for amputees evaluated by Medicare Functional Levels (K‑levels), particularly K2 (selectively), K3, and K4 candidates. Coverage requires documented functional need (e.g., daily/frequent ambulation including ~400 continuous yards), adequate physical and cognitive capacity, appropriate healing and trial/temporary prosthesis use, is limited to one service every three years, and excludes swing‑phase‑only MPKs, certain powered or osseointegrated devices as experimental, and other specified noncovered items; it applies to fully insured plans but not ASO groups unless elected.

"Coverage required for an orthotic device or orthotic service for HCSC members residing in Arkansas."