Prosthetics and the NDIS: Getting started.

A prosthetic limb can transform the life of someone who has lost a limb through an accident or amputation, or who was born without one or more limbs.

Prosthetics are one of the most sophisticated forms of assistive technology and potentially one of the most expensive, so the NDIS rules can be complicated.

Today we take a deep dive into prosthetics and what the NDIS is likely to fund.

Meeting NDIS requirements for prosthetic limbs.

There are many types of prosthetic limbs that vary in complexity and the functions they provide. A prosthetic may be a simple device that is all about function or a more enhanced version that looks and performs like a natural limb. [1]

The NDIS has a dedicated guideline for prosthetic limbs. It considers the following factors when deciding on the amount of funding that it will provide for prosthetics:

• Your weight
• Your goals
• Your ability to use, put on and remove the limb
• Your ability to care for the limb
• Medical needs such as the residual limb shape and skin integrity.

Value for money.

Due to the expense associated with prosthetic limbs, the NDIS must be satisfied the purchase represents value for money. It will take into account the following:

1. The cost must be reasonable and relative to the benefits it offers you. The cost includes labour and engaging a prosthetist, while benefits may be your ability to complete everyday tasks independently or work.
2. The value of the prosthetic compared with the cost of alternative supports or similar components that may meet your needs and goals. That means the NDIS may consider the cost of providing alternative or lower grade options.

For any assistive technology, the NDIS will only usually fund items that are the minimum grade required to achieve the needs of the participant. For prosthetics, the minimum grade requirement applies to socket materials, componentry and coverings.

The NDIS will consider the following regarding grades of components:

• Your expected or known level of function
• Functional needs related to your usual surroundings such as floors
• Demands on the limb.

What are K levels and how does the NDIS view them?

You will sometimes see prosthetics referred to according to a ‘K’ classification. There are five functional levels for prosthetic users from K0 to K4.

The NDIA will fund prostheses for participants up to K2 classification and consider higher prostheses for people up to K3 and K4 classification.

What the NDIS may fund:

• Assessment and specification
• Manufacture
• Some maintenance, repairs and component replacement
• Set up, delivery, fitting and major adjustments
• Other costs such as residual limb socks and sheaths (6 per year)
• Some upper limb myoelectric prostheses
• Limbs external to osseointegrated implants
• Professional advice and support to build independence.

What the NDIS will not fund:

• Interim prosthetics for rehabilitation
• High cost supports that do not demonstrate greater benefits or value for money
• Repairs or maintenance covered by consumer guarantees or warranties
• Repairs due to damage caused by misuse
• A secondary or spare prosthetic limb.

Secondary waterproof prosthetics are only considered if they are connected with your goals and associated with recreational supports.

If your preferred support is not fully covered by the NDIS due to it having a higher level of function or customisation, you can contribute personal funds.

Getting started with supports.

A prosthetic limb is a stated support under the NDIS and can only be added to an NDIS Plan after a formal assessment.

The NDIS will usually fund replacements at approximately three year intervals or sooner if required for children under 18.

Leap in! can help. 

We specialise in supporting our members at each step of the NDIS process – from preparing for their first NDIS Plan to managing budgets and paying providers.

To get in touch with our experienced team, call 1300 05 78 78, email crew@leapin.com.au or chat with us online.

[1] NDIS, Including specific types of supports in plans operational guideline – Prosthetic limbs, accessed 31 May 2021. 

Further Reading

Specific supports: prosthetic limbs.

Occupational therapists: What they do and how they can help you.

Will the NDIS pay for repairs and maintenance to assistive technology?