VA Contract Template

Statement of Work

4.4 Outcome Monitoring and Utilization:

VA may prescribe and authorize an automated prosthetic utilization and function monitoring device for data collection and analysis for new lower extremity prosthetic limbs (transtibial, knee disarticulation, transfemoral and hip disarticulation level; does not include socket replacements). The device will have the ability to record intensity, endurance, gait symmetry, dynamic function, including alignment, forces and moments with proven accuracy.

The device will monitor and continuously record the following:

  • Stance and swing time for gait symmetry, dynamic function including alignment, forces, and moments;
  • Cadence and cadence variability;
  • Step count – continuous recordings of total step count;
  • Number of steps per selected time interval;
  • Longitudinal, historical and objective analysis;
  • Peak performance index, quantifiable into baseline and faster than baseline rate of walking, distance and variable cadence;
  • Functional level assessment capability; and
  • Measurement of socket load during gait

VA may request “Veteran Outcome Reports” based on the data collected. The reports shall contain narrative and graphical representation of the above variables.

Fee Schedule

§3.2 Veteran Outcome Utilization Device:

VA may prescribe and authorize an automated prosthetic utilization and function monitoring device for data collection and analysis for new lower extremity prosthetic limb. For any utilization and function monitoring device authorized, VA may request “Veteran Outcome Reports” as described in the Statement of Work for this solicitation. The Contractor shall be paid subject to the following guideline for a utilization and function monitoring device and associated report(s):

  1. CMS HCPCS L5999 (lower extremity prosthesis, not otherwise specified – outcome device(s)) code shall be used to reimburse the Contractor for the utilization and function monitoring device.
  2. Total reimbursement for the device and outcome report(s) will reimburse in accordance with the NOC L-Code item reimbursement guidelines referenced in Section 2.2. The total reimbursement includes the device and outcome report(s). Outcome report(s) requested by VA shall not be reimbursed separately.

This is a one-tome billable charge for the utilization and function monitoring device and associated outcome report(s) for new prosthetic limbs only.