Microprocessor-Controlled Foot/Ankle System Now Covered by Anthem and Others

Effective May 20, 2021, Anthem Blue Cross considers a microprocessor-controlled foot or ankle system (e.g. PROPRIO) as medically necessary when the following criteria is documented in the medical records:

• Patient has adequate cardiovascular reserve to master higher-level technology
• Patient has cognitive ability to learn about the technology
• K3 or above functional level
• There is a reasonable likelihood of better mobility or stability using the microprocessor-controlled ankle/foot than is with the use of a mechanical foot
• The medical documentation regularly ambulates in situations where the device will provide benefit (e.g., ascend/descend stairs, traverse uneven surfaces or walk long distances)

The above criteria must be documented in the patient’s medical record along with any assessment results and/or corroborating documentation from other healthcare practitioners.

This policy change is adopted by the following health plans as of May 1, 2021:

• Amerigroup Real Solutions
• Anthem
• BCBS Georgia
• BCBS Minnesota
• BlueChoice HealthPlan of South Carolina
• Community Connect Health Plan
• Empire BCBS
• Healthlink
• Simply Healthcare
• Unicare

Other large payers currently consider microprocessor-controlled ankle/feet to be medically necessary under same or similar conditions as mentioned above.

You may read the full policy on anthem.com.

If you have further questions about the coverage requirements, contact us directly at [email protected].