Over the years, we have provided prosthetic service to many people all over Illinois at their residences, nursing homes, assisted living faclities and in the hospital. The question of pricing does comes up for prosthetics fairly often and our goal here is to help give you the answer you are looking for. If you have read our other information, you know that transparency is our goal and we would like to help you find the answers you are looking for in all areas prosthetics & orthotics. This article describes about cost price of Below Knee Prosthetic Leg With Suction.
The price for a below knee prosthetic leg with suction suspension can range from $5919.00 to $ 16,675.00 approximately.
This article will be cover these costs, but as you can see it must be presented, especially at first, in a range.
We did gave this range to try and inform you about the real world of prosthetics.
If we gave you one price, we would be misleading you and that is not our intention. If you just wanted a simple range of costs, then great. There they are there above us, but if you want to understand your prices more specifically, then take the $5919 and plug in the foot codes we will talk about shortly. Again, we realize there are variances, but we are trying to give you a good ball park cost here with a good amount of supporting information.
Having said this, we will soon show you how you can get close on the cost that will be yours, based off not only the foot but also what your K Level is. (More on K Levels shortly.)
Please note that these are ONLY the costs, if you were paying in cash. Your insurance or other coverage can pick up 80-100% of the cost, if all documentation, medical necessity and deductibles are met in many instances. So, as you can see there is another layer to this equation, which can help you negate the dollar amounts you see above.
In the world of prosthetics you will find that price varies a lot on quantity of the items you receive and the sophistication of the componentry you are given.
If you are new to prosthetics, you might be wondering what componentry is.
“Componentry” is the term used to describe the parts of the prosthesis that come together to form a complete system.
You already know that just like with other purchases you have made in the past that there is standard version and then there are premium versions of goods sold.
The needs of the user matter and sometimes a person might only need a basic system while others need a lot more sophistication of movement or range of motion that will require higher end componentry.
Moreover, many parts of the prosthesis have a certain L code attached to it. And, each L code has a dollar sign attached to it. Please note that the price of each L code is not set by the prosthetist. Coverages (such as insurance, etc) tell a prosthetist what an L code reimburses at, not the other way around. Meaning, the pricing structure is not founded by the person giving you the prosthetic leg. This is good because it holds the pricing to a more uniform spectrum of costs and a greedy salesman can not skyrocket the price on you out of the blue. It is regulated.
We will provide a list of L codes below that we believe are common for a suction type, below knee (bk) prosthesis.
We also give common quantities for a certain number of those L codes provided.
For example, sometimes people are given two gel liners and this is done to help with hygiene and longevity of the liner (For example, if you got two gel liners you can switch them out routinely).
As far as quantities go, after having read this, you can now opt for a quantity of one, in the situations where 2 are offered and your price could go down, for example. This is not always recommended from a treatment standpoint, but when it comes to a cash analysis, you could reduce some quantities to get closer to the price you require.
We think you get the general point.
Not all amputees get a suction system either, but we are presenting this for those of you who are interested in learning more about these costs. If you want to learn more about below knee prosthetic leg costs for a pin type suspension system, you are welcome to read our other article located under the pricing tab. Pin locking systems for below knee amputees are in the same realm of the costs mentioned here, but there are a few key differences.
The Prosthetic Foot
A large part of the price of a prothesis is the foot. An expensive high end foot can really change the range of cost by $7929.00, for example. Just taking that number (7929) right off of the top of the high end price and replacing it with a $394.00 foot can really change the equation for you. For example, someone who walks up and down curbs but doesn’t walk very fast or far, is a K2 ambulator (walker) typically. K2 ambulators typically do not require the K3 or K4 foot that costs $7929.00. Does the K3 or K4 foot move a lot more fluidly? Absolutely. But if we are trying to minimize costs and just want to get from A to B, then maybe the $394.00 foot isn’t so bad after all.
*Please note we will get into what a K Level is shortly, but for now, just know that a “K2” in general is more basic than a “K4” is. The K4 ambulator (walker) usually is someone who can walk slow, fast and run. Both are amputees, but their functional levels are different.
Prices for Prosthetic Feet With The Different K Levels
K1 feet, as you can already see are very basic. Not bad, just basic in design. The price is minimal and is often
incorporated into the L5301 hcpc code that you will soon see below.
The next level of feet are for a K2 ambulator. This foot can itself vary in cost, but it still remains on the lower end of the spectrum. With one very common distributor, we have seen that the codes for K2 feet can lead us to a price of $394.00 on up to $1166.00, for example.
The next level above K2, as you probably already figured out is K3. A K3 foot has more range of motion and sophistication of movement. Within this foot type, there are many prices that can be seen. The range basically has a price within every thousand dollar mark from $2,000.00 up to nearly $8,000.00. Prices that are seen within this K level are : $2480, $3395, $4167, $5971, $7010, $7929. – We rounded to the nearest dollar for simplicity.
Lastly, there is a group of K4 feet. These feet are typically reserved for athletes. People who exhibit high impact tendencies such as hiking or running for example and are more apt to use the premium feet, lest they break the K3 versions due to over stressing the K3 or K2 range of motion repeatedly. These feet can vary in price, but some of the prices we have seen for K4 feet are : $3318, $4151, $7929, all within the same K4 family.
Check out our other article on prosthetic feet if you want to take a closer look at everything related to prosthetic feet.
Cash Prices & How Insurance & Other Coverages Can Assist
The prices mentioned above are cash prices. But we all know that medical coverage, like insurance for example can assist with reducing your out of pocket expenses. This is nothing new. Having said that, it is very possible that your costs can be reduced by 80-100 percent given the amount of coverage you have. Also, your deductible for these insurance plans, for example will come into play as well.
Please remember that the costs of the feet above are some common prices you will find, there are other prices that exist and this will be more clarified in other articles we write. There are more than 270 prosthetic feet on the market and prosthetic feet deserve a full article unto themselves in terms of pricing. We did try to give you some common prices though so you have a general feel on costs.
Other Cost Factors For A Prosthetic Leg, Beyond The Foot
Are you aware of what your K Level is?
At a glance, your “K Level” is how well you can move around independently.
A K level like we keep referring to directly relates to your ability to walk certain distances and perform certain activities of daily living. Not everyone is a runner for example. Not everyone goes on long walks at fast speeds even. Some folks walk on level surfaces and get the mail. Some people stay inside mostly. It all varies.
You can see the way in which price can go up and down now probably.
K Levels In Much More Detail
K zero :
This level of functionality is minimal. Many of these amputees might now want to walk or can not do so due to physical challenges.
K 1 Level :
An individual who walks on level surfaces. This individual is most likely in their residence often times. The foot that is directly related to a K1 ambulatory (walker) is a SACH foot. SACH stands for : Solid Ankle Cushioned Heel. In essence it is a very basic foot. K1 walkers most likely consider the use of a cane or walker for example.
K 2 Level :
Someone who can walk slightly more than a k1 ambulator. They can step up and down curbs generally. But the
ambulation is still very simplified. The cadence is at a fixed speed. As shown above in the sections about general foot costs you can guess (without even knowing a lot about K Levels) that the price can vary from $394- $7929.
K3 Level :
A person who has reached a level of K3 can obviously do more than a K2 ambulator. The big difference is the speed at which they can walk. Basically they can walk fast and slow and can walk greater distances than a K2 ambulator typically. A K3 walker is someone who is referred to as a “community ambulator” and can do more slopes, inclines and declines as compared to a curb as mentioned above in K2.
K4 Level :
someone who can be extremely active. Usually, this level of amputee is someone who can perform in sports. Think athlete when you think of a K4 amputee. They don’t have to be an Olympic athlete, but someone who really is another step above a K3 functional level.
The levels indicated above are not always where the amputee might be a particular moment in time. K levels have a lot to do with potential and where a person will be in the near future. If you are amputee reading this make sure to discuss your abilities directly before an amputation with your doctor and prosthetist. Documentation of this information is an important part in verifying someone’s k level.
Looking At Price Beyond The Foot
The following is a list of L codes that pertains to a suction style prosthesis. We came to these prices by taking two well known coverages and averaging them. Their prices are often times very similar so the numbers are not skewed, per se. We rounded prices up the next highest dollar if the cents mark was at 50 cents or higher.
L5301 : $2635.00
L5620 (x2) : $292 x 2 = $584
L5629 : $311.00
L5637 : $377.00
L5647 : $ 698.00
L5685 x2 :$113.00 each x 2 = $226.00
L5679 : $578.00
L5910 : $354.00
L5940 : $491.00
L8420 (x2) $19 x 2 =38.00
L8440 (x6) $45.00 x 6 = $270.00
L8470 (x6) 6.00 x 6 = $36.00
Addition of a flexible inner liner – L5645 : $958.00
With Addition of a custom protective cover – L5704 : $615.00
And Addition of a protective skin – L5962 : $575.00
Again, please keep in mind that the price we are sharing will be affected depending on your insurance or other coverage (if any). There are many different insurance plans and sub-plans, available to patients, therefore it can be difficult to determine exactly how much you will pay out-of-pocket without first contacting your insurance and knowing exactly the kind of prosthesis you will be getting from your prosthetist.
Some insurance plans may cover up to 80% – 100% of the leg; other plans may come with higher deductibles, which may lead to larger costs for you up-front before your coverage begins. It is best to contact your individual insurance plan for more information. But now you know the common L codes that you could possibly run into. As a result, you will be more equipped to get the answers you are looking for. Especially if you go directly to the insurance company and not have the prosthetic company help you get the quote of benefits of your plan.
The best price range we can offer for the prosthetic leg as mentioned is $5919.00 to $ 16,675.00. (We will discuss elevated vacuum in another article.) This is our attempt, based on previous data, to give you the best information possible to make your decision. The range varies based on two main factors
1) higher costs based on prosthetic add-on features and
2) reimbursement levels, which vary across states and from year to year. Most people do not pay cash for a prosthetic leg. However, if you do choose cash, this range provides you with a way to prepare financially for upcoming costs.
To help you decrease your costs, especially if you are paying with cash, one solution would be to ask your prosthetist to do one test socket.
Another solution may be to ask your prosthetist to provide only one gel liner (though most people opt for two gel liners for hygiene’s sake and for preservation).Though these are not in line with best practices and could affect your overall treatment, these may be a cost-effective compromise to get you closer to the lower range of $5919.00.
If you lack insurance, Medicare, or Medicaid, you could also contact your prosthetist for an alternative payment program. For those with insurance, there are no compromises on price. It is frowned upon to alternate between charging people cash for a discount and charging insurance at other times.
We hope this article has been some help to you in determining a price for a prosthesis that you may be seeking. We wanted to get you close to the price and illustrate why the price may vary.
*Rinella Prosthetics & Orthotics can not be liable for the prices you may encounter at other facilities. They may use more or less L codes and quantities that we can not control. We hope you understand that this will make the price change and without seeing you ourselves, we have no say in how it is priced out.