Microprocessor-Controlled Prostheses for the Lower Limb

When Policy Topic is covered Microprocessor knees that have stance-phase or swing-and-stance phase microprocessors may be considered medically necessary only for those patients who meet ALL of the following criteria:  Patient is an appropriately active community ambulatory; AND  Patient has undergone extensive evaluation using the Hanger Prosthetics & Orthotics Patient Assessment Validation Evaluation Tool (PAVETTM Evaluation for microprocessor Knee form, which is available, click here); AND  Patient’s PAVET scores are between 40 and 72 as detailed in the Table below.