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The following list represents examples of componentry that may be appropriate for a client with an osseointegrated lower limb prosthesis and are expected to be afforded within the total PharmaCare funding amount available to these clients every three years.
Note that these are examples only and other components or supply/component categories (e.g., repair kits) may be approved if requested and justified. Osseointegration clients are eligible for PharmaCare coverage of microprocessor knees which are normally non-benefits for clients with conventional socket prostheses.
| Osseointegration components | Sample details / part # |
|---|---|
| Taper sleeve | Mac #305024 / Ortho #78500030 |
| Dual cone adapter | (Sample BM101T6-1) |
| Bushing – has sheer pin | Mac #305124-3 / Ortho #78500100; 78500106; 78500112 |
| Pylon adapter | 2R38 |
| Tube clamp | 4R52 |
| 2 locking screws | # 78500040 78500060 Mac 305064, 305065 |
| Knee connector (clamp) different sizes or offset | Knee connector – different sizes or offset MAC 305105 (L); 305106 (R) / Ortho #78500206; 78500212; 78500215; 78500218; 78500221; 78500224; 78500306; 78500312; 78500315; 78500318; 78500321; 78500324 |
| Silicone cover/cap – covers abutment | Mac #306000; Ortho #78500020 |
| Foot | Vari-Flex Pyramid (note this foot includes vertical shock) |
| Foot | PLTO Pro-Flex LP Torsion (no torsion adapter) |
| Torsion adapters | 4R39 (torsion adapter) only with Vari-Flex foot |
| Positional rotator | 4R57 (button to twist) |
| Microprocessor knee | Rheo |
| PIN (left) | PIN (right) | Abbreviation | Level of amputation | Maximum reimbursement |
|---|---|---|---|---|
| 77123546 | 77123547 | TF-Osseo | Transfemoral osseointegration | By approval |
| 77123559 | 77123558 | TT-Osseo | Transtibial osseointegration | By approval |