K-levels are the rating system established by Medicare to indicate a person’s rehabilitation potential. The system gives a rating from 0 through 4 and indicates a person’s potential to use a prosthetic device if they had a device that worked well for them and they completed rehabilitation to use the device properly.

Your K-level designation is important because it is the driving factor in the decision on what prosthetic device to provide to you and the payment for that prosthetic device. Payment by Medicare, and most insurers, is guided by the amputee’s K-level designation.

Insurance companies want to ensure that when they pay for a prosthesis, the amputee will likely be able to use the device. Insurance companies do not want to pay for an expensive prosthesis only to have the amputee not use it because it is unrealistic for the person to be up and about. On the other hand, insurance companies also want to be sure that if the person has the potential for walking about in the community, getting back into hobbies, sports, and other recreational activities, that they receive a prosthetic device that will allow the amputee to successfully do those things. In short, the prosthesis should match the person’s need and potential.

There are several outcome measures used to establish K levels which include;

• Amputee Mobility Predictor (AMP)

• Patient Assessment Validation Evaluation Test (PAVET)

• Prosthesis Evaluation Questionnaire (PEQ)

• Timed Up and Go (TUG)

• Timed Walk Tests

• Distance Walk Tests

The Amputee Mobility Predictor (AMP) is the most frequently used outcome measure. The AMP can be administered in as little as fifteen minutes on patients with (AMPPro) or without a prosthesis (AMPnoPro).

Below are Medicare’s descriptions of the five (0-4) K-Levels

Level 0 – Does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.

Level 1 – Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator.

Level 2 – Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator.

Level 3 – Has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.

Level 4 – Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.

Five Facts Every Medicare Patient With Limb Loss Should Know;

1. Do you know the K-level your physician has determined for you? This will be a number between 0 and 4.

2. Has your physician properly documented in your medical record all of the information needed to determine your K-level? Ask your physician how the documentation supports the need for your prosthesis.

3. Be sure your prosthetist fits you with a prosthesis that is appropriate for your K-level.

4. Your K-level affects the kind of foot and/or knee your prosthetist can incorporate into your prosthesis.

5. Visit your physician regularly (every 6-12 months) to maintain complete documentation of your prosthetic care. Discuss your prosthetic use with your physician, including your current and potential K-level; the condition of your residual limb; your socket fit; how your prosthesis is functioning; and any activities that you are unable to perform in your current prosthesis that you would like to be able to do.

For more information about K-Levels, check out “Do You Know Your K-Level” by the Amputee Coalition.