This category refers to prostheses or orthoses that are designed and customised to meet an individual’s specific needs. These are typically prescribed by a licensed professional and require specialist skills to produce.
Prosthetic limbs (aka artificial limbs) are used by people who are without all or part of a limb, either due to a birth defect or an injury. They are designed to function in a way that is similar to a natural arm and leg, helping people with disability perform daily tasks and improving their quality of life.
To qualify for NDIS funding, prostheses and orthoses must have “value for money.” In other words, the costs of a prosthetic limb must correspond to the benefits it offers. Specifically, the NDIS has to be convinced that:
- the total labour and associated costs, including the number of hours and hourly rate of the prosthetist, represents value for money in the participant’s local market, and
- the cost of componentry proposed represents value for money when compared to the cost of similar prosthetic components that would meet the participant’s functional needs and goals.
The level of a prosthetic’s sophistication must also correspond to the person’s individual circumstances and characteristics, including their ability to use and care for the limb, their personal goals and aspirations, as well as their weight and medical needs.
Entry level and standard grade prostheses are generally funded by the NDIS. So are repairs, maintenance, and adjustments.
On the other hand, the NDIS will not cover costs associated with repairs to limbs that have been damaged as a result of being used outside of recommended use and care guidelines. Spare prosthetic limbs also are not covered unless the NDIS is satisfied that the spare limb is “reasonable and necessary.”