Amputees face loss of insurance coverage for their prostheses

Proposed changes will lower standards of care to a level last seen in the 1970s

Aug 18, 2015, 12:06 ET from Virginia Prosthetics & Orthotics, Inc.

ROANOKE, Va., Aug. 18, 2015 /PRNewswire/ -- Amputees across the U.S. who use prostheses face losing their Medicare, Veterans Administration, and private-insurer coverage for artificial limbs – and access to this medically-necessary equipment – because of a policy change proposed by The Centers for Medicare and Medicaid Services (CMS).

A coalition of amputee advocacy organizations and O&P industry groups developed and are asking people to visit the site now to sign a petition protesting the changes and to share their opinion about the proposed changes with CMS.

CMS recently issued a proposed Local Coverage Determination (LCD) for Lower Limb Prosthetics that would, according to local and national orthotics and prosthetics (O&P) industry experts, lower Medicare beneficiaries' and eventually all amputees' care to a level last seen in the 1970s.

"Nothing about these proposed policy revisions benefit the patient in any way," says J. Douglas Call, CP, President and CEO of Roanoke, Virginia-based Virginia Prosthetics & Orthotics, Inc. "Instead, they dramatically reduce amputees' access to the current standard of prosthetic care. Specifically, the changes threaten amputees by downgrading the prosthetic limb they receive, delaying delivery of medically necessary prostheses, and even restricting access to prostheses by imposing higher, unaffordable, out-of-pocket costs." 

The proposed LCD is a comprehensive re-write of Medicare's entire lower limb prosthetic benefit, and it is opposed by national amputee and O&P industry groups, including the Amputee Coalition of America (ACA), the American Orthotic & Prosthetic Association (AOPA), and the National Association for the Advancement of Orthotics & Prosthetics (NAAOP). 

"While there are numerous issues with the LCD that threaten patients' access to prostheses and medically-necessary care, the most egregious issues – and the ones that I find particularly offensive for patients – are those that discriminate against specific amputees," Call says. "Amputees who don't walk with what CMS subjectively describes as 'a normal gait' or those amputees who use a cane or crutches instead of putting on their prostheses when they get up in the middle of the night are defined by CMS as having a prosthesis that's not medically necessary, and therefore the costs for which aren't covered.

"It's discriminatory. It's unfair to amputees. And it needs to change," Call adds.

While the LCD would initially affect only those amputees receiving Medicare benefits, its changes would undoubtedly grow to impact all amputees, Call and industry officials agree. That's because many of the proposed policies involve major changes to the Uniform Code Set which all insurers, including the Veterans Health Administration, use to cover and pay prosthetic limb claims.

Call and O&P industry representatives want the LCD to be withdrawn, or at the very least to have revisions made to the draft policy that, when implemented, would ensure timely and appropriate patient care. At the same time, the group is also calling for prosthetic-industry experts to be engaged in developing future CMS policies to ensure they are based on science and valid clinical evidence, instead of creating financial policies disguised as medical ones.

A grassroots effort is underway nationally to help generate amputee, public and industry awareness by obtaining amputee comments and impact statements at  

"Advancements in artificial-limb technology are progressing at the fastest rate in the O&P industry's history and patients are benefitting through improved mobility, better health, and increased productivity – all of which save taxpayers, Medicare and insurers money," Call explains. "We can't let these ill-conceived changes lower amputees' standard of care to a level last seen nearly 50 years ago. That's why we're fighting for local amputees, and for a change."

About Virginia Prosthetics & Orthotics, Inc.
Virginia Prosthetics & Orthotics, Inc. serves numerous locations throughout southwest and central Virginia. Founded in Roanoke in 1966, the company is Virginia's oldest and largest O&P provider, helping patients believe in their possibilities through the use of advanced prosthetic and orthotic technology. Additional information is available at or by calling 1-888-366-8287.


SOURCE Virginia Prosthetics & Orthotics, Inc.