EnableNSW

Prosthetic Limb Service - How to obtain a prosthetic limb

The Prosthetic Limb Service (PLS) is a disability support program administered by EnableNSW which provides funding for prosthetic limbs.

Eligibility

To be eligible for funding from the PLS, you must be living in NSW or Lord Howe Island, be eligible for Medicare and not be eligible for assistance through another government program.

Eligible residents are able to receive an interim limb from the PLS as part of their rehabilitation program. People 65 years or over will continue to receive funding support from the PLS to manage their ongoing prosthetic needs. People under 65 years, who do not require ongoing rehabilitation to use their prosthesis, will now be supported by the National Disability Insurance Scheme (NDIS). An access request directly to the NDIS should be made as early as possible (three months after your amputation) to ensure a smooth transition post rehabilitation.

Eligible veterans under the Department of Veterans Affairs (DVA) may receive services through the PLS, however funding is provided by the DVA.

What is available through the program?

The PLS provides a standard prosthesis and an annual allocation of consumable products which may include:

  • 12 stump socks or sheaths (including gel socks) per residual limb; and
  • 2 stump shrinkers per residual limb; and
  • 1 roll-on liner per residual limb; and
  • 2 pairs of cosmetic stockings per prosthetic limb.

Specialised components such as high cost feet or knees may be provided in exceptional circumstances. Additional information should be submitted by your prescribing doctor if required.

How much does it cost?

Some people are required to make a contribution towards the cost of their prosthesis. If you hold a current pensioner concession card, healthcare card or Commonwealth senior’s health card, you are not required to pay anything.

People on higher incomes are required to pay 15 per cent of the cost of services provided. This contribution is capped at $200 per financial year.

If you would prefer a prosthesis that is more expensive than the one prescribed, you may choose to fund this or more expensive parts yourself.

How does it work?

Your interim prosthesis (first limb after surgery) will be prescribed in an EnableNSW accredited amputee clinic. If you are an inpatient in a private hospital, EnableNSW can accept a prescription only after you have been discharged and become an outpatient.

All interim prosthesis requests are sent to EnableNSW for approval. If you are under 65 years, and have completed your rehabilitation program, you will need to make an access request directly to the NDIS for ongoing prosthetic supports. It is recommended that an access request be made at three months (post-amputation) to ensure the NDIS has enough time to prepare your plan for when you are ready to move to your definitive limb. The NDIA has some helpful information on their NDIS website to help you get started.

After your interim prosthesis has been prescribed the process is as follows:

  1. Your amputee clinic sends the prescription form to EnableNSW for approval
  2. Once approved, EnableNSW advises your Prosthetic Service Provider (PSP) and the limb is manufactured
  3. The PSP will then contact you to make appointments for fitting
  4. Once you have confirmed that you have received your limb, EnableNSW will pay the invoice.

Can I choose my limb manufacturer?

Your local amputee clinic will prescribe the most appropriate prosthesis to meet your needs. All interim limbs are made by the prosthetic provider appointed to your clinic*.

When you need a definitive or replacement limb or repairs and consumable supplies, you may choose from a list of accredited prosthetic providers.

Once you have your script you may take the script to the provider of your choice from the approved list.

*If you are receiving an upper-limb prosthesis or attend a clinic in the Sydney Children’s Hospital Network these arrangements are slightly different. Please speak with your prescribing doctor for more information.

*If your interim prescription was raised while you were an outpatient at an accredited private hospital clinic, you may choose your prosthetic provider.

Care of your prosthesis

Your prosthetist will provide information about how to care for your limb including an outline of what activities the limb can withstand and also how to clean your prosthesis.

Responsibility for care of your prosthetic limb rests with you and EnableNSW may not repair or replace limbs which are damaged through neglect or misuse.

Repairs and maintenance

Your limb will need regular maintenance however you should not attempt to modify or repair the prosthesis yourself.
Maintenance and repairs should be carried out by an accredited manufacturer and can be organised through your Prosthetist.

The parts of your prosthesis are expected to last 2–3 years. When these need to be replaced the team at your amputee clinic will prescribe a new prosthesis.

People 65 years or over will remain eligible for the PLS and EnableNSW will continue to cover the cost of your ongoing prosthetic needs including limbs, repairs and accessories (socks and liners).

EnableNSW will cover the costs of repairs and maintenance, including accessories (socks and liners) for interim limbs as part of your rehabilitation program.

EnableNSW will not cover repairs and maintenance for items or components you choose to fund yourself.

Important information for people eligible for the NDIS

  • If you are eligible for the NDIS, you must ensure you have the right level of NDIS funding to cover limbs, repairs and accessories (socks and liners) for the period of your plan. You should work with your Prosthetic Service Provider (PSP) before your NDIS planning meetings. They will tell you how much funding you are likely to need in your plan to cover your prosthetic needs over a 12 month period.
  • If you do not have the right level of funding in your current plan you should contact your NDIS Local Area Coordinator or support coordinator to discuss your requirements. The NDIS website has some helpful information about plan approvals and what you can do if you are not happy with your current level of funding.
  • You should continue to attend your Amputee Clinic appointments as part of your overall healthcare and prosthetic management. Your clinician will also give you the best chance for a successful NDIS Assistive technology (AT) outcome by providing the right documentation and clinical information.

Compensation

You are legally required to advise us if you receive compensation in relation to your limb loss.

If you are planning to file for compensation you should also let us know. This will not prevent you from receiving assistance however you may be required to reimburse EnableNSW if your claim is successful.

Feedback

We are committed to providing a simple and efficient service. Please contact EnableNSW if you have any concerns or suggestions for how the service could be improved.

If you are not satisfied with the service you receive on the phone, please ask to speak to a senior staff member who will assist you further.

For more information

Contact EnableNSW for more information.