Myomo, a wearable medical robotics company, announced that the Centers for Medicare & Medicaid Services (CMS) published a final rule classifying the MyoPro orthosis under the brace benefit category.
Braces are paid on a lump sum basis under the Social Security Act. The finalization of MyoPro’s classification as a brace paid on a lump sum basis, rather than on a capped rental basis, brings Medicare payment methodology in line with how all other insurance plans currently pay for the MyoPro.
The rule is expected to be published in the Federal Register on November 13, and will be effective on January 1, 2024.
“On behalf of the many stroke survivors and others with long-term muscular weakness or partial paralysis with Medicare Part B insurance, we are pleased that CMS has moved forward to facilitate access to the MyoPro brace,” said Paul R. Gudonis, Myomo’s chairman and CEO. “The MyoPro has been shown to be effective for Medicare beneficiaries with the requisite medical necessity, and this reclassification is very supportive of CMS’ goal of health equity for this population.”
The MyoPro has already been covered and paid on a rental basis for five Medicare beneficiaries covering all of Medicare’s billing regions after review of their medical documentation. Future claims for devices delivered to patients are expected to continue to be reviewed on a claim-by-claim basis.
A national fee for the MyoPro has not yet been established, so claims will continue to be paid by the Durable Medical Equipment Medicare Administrative Contractors at regional rates until a national fee is determined. In the final rule, CMS states that it intends to issue a payment determination in conjunction with its second biannual nondrug public meeting to be held later this year or at the subsequent biannual public meeting in 2024.
