Insurance & Billing

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Coordinated care from surgery to payer source and beyond.

Whether you’re a patient looking to verify coverage or a healthcare professional seeking to refer a patient, P&O Care takes a proactive approach navigating through insurance and billing processes and coordinating outcomes with patient care teams.

Accepted Insurance

Please call your insurance company to verify your coverage for prosthetics and/or orthotics and to verify your coinsurance percentage and deductible amount.

Our office staff is available to assist you in confirming your coverage and financial responsibility, including your options for out-of-network insurance coverage.

Medicare Referrals

Currently, activity levels are subjectively determined through the collaboration of the medical team. Prosthetists, physicians, physical therapists and case managers determine K Levels based on a user’s:

  • Medical History
  • Daily Needs, Hobbies and Occupation
  • Pre-Amputation Activity Level
  • Post-Amputation Activity Level
  • Expected or Potential Activity Level after receipt of prosthesis

IT IS IMPORTANT TO NOTE
A patient’s age, use of an assistive device, such as a cane or walker, or specific level of amputation do not exclude users from certain K level ratings. Occasionally, strength and agility tests are utilized to help the team determine the appropriate activity level.

There are 5 K level classifications:

KO Level

Patient Profile
Patient does not have ability or potential to walk or transfer safely with a prosthesis.

Prosthesis Candidate?
No. A prosthesis would not enhance this user’s quality of life or mobility.

K1 Level

Patient Profile
Patient has the ability or potential to use a prosthesis for transfers or walking on level surfaces at a single speed, typically indoors. Patient may need assistance of another person to safely transfer.

Prosthesis Candidate?
Yes. Simple, lightweight components are used for K1 prostheses.

K2 Level

Patient Profile
Patient has ability or potential to walk at a single speed, climbing low-level environmental barriers such as curbs, stairs and some uneven surfaces.

Prosthesis Candidate?
Yes. Some K2 users use an assistive device such as a walker cane for safety and walk both indoors and outdoors.

K3 Level

Patient Profile
Patient has ability or potential to walk with a prosthesis at multiple speeds. Able to walk on uneven ground and climb all environmental barriers such as stairs, curbs, ramps.

Prosthesis Candidate?
Yes. Many prosthetic users fall into this category. A K3 user may sometimes use an assistive device for safety.

K4 Level

Patient Profile
Patient has ability or potential to walk with a prosthesis far beyond basic walking, including running and high impact activities.

Prosthesis Candidate?
Yes. Often, children and athletes are classified in the K4 level.

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Are you looking to refer patients for prosthetic or orthotic care? Let’s get started!

Contact us to learn more about P&O Care’s insurance and billing options.

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