Prosthetics - MEDICAID - OKLAHOMA

This policy covers prosthetic devices and components for replacement of missing body parts, including lower‑extremity prostheses and test sockets (Symes, BK, AK, knee disarticulation, hip disarticulation, hemipelvectomy), prosthetic knees and feet (SACH, multiaxial), donning sleeves, and upper‑extremity systems (body‑powered and myoelectric). It applies to patients with limb loss from conditions such as diabetes or occlusive arterial disease and to ambulatory populations (community ambulators, active adults, athletes); major limitations/requirements include member plan coverage determinations, device‑specific functional prerequisites (sufficient shoulder/stump motion for body‑powered devices, detectable EMG for myoelectric devices), component performance limits (e.g., SACH foot lacks dorsiflexion), and additional restrictions in the policy’s Coverage Limitations section.

"Neuroma preventing individual from being able to bear pressure on the residual limb"