On November 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published final rule CMS-1780-F that codified the Medicare definition of a brace to the regulations at 42 CFR 410.2. This rule finalized that powered exoskeleton devices that support a patient’s weak arms or legs are classified as braces due to their use in stabilizing, positioning, supporting, and restoring the functions of the patient’s weak limbs. The Durable Medical Equipment Medicare Administrative Contractors, Noridian and CGS, have now posted the new coding language to their websites.
Lower-limb powered exoskeleton devices support the weak legs for a patient that can perform ambulatory functions with the device. Ambulation may include the assistance of a cane, crutches, or a walker to return to mobility activities of daily living. Upper-limb powered exoskeleton devices are used for chronic upper-limb weakness; these custom fabricated orthotic devices are used to support and assist movement, thereby promoting functional activities of daily living.
The Healthcare Common Procedure Coding System (HCPCS) coding is as follows:
- K-1007(bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors) describes a wearable, motorized, and computerized device, functioning as a single or double upright microprocessor-controlled hip, knee, ankle, and foot exoskeleton. It integrates motion sensors, an onboard microprocessor system, and an exoskeleton frame, designed to support and enhance natural limb movements during walking. There are no additional add-on codes for this exoskeleton device. This powered exoskeleton device is custom fitted per the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Quality Standards, Appendix C.
Effective for claims with dates of service on or after June 1, the only products that may be billed using HCPCS codes K-1007 are those that have received mandatory code verification review and are listed on the Product Classification List (PCL) of the Pricing, Data Analysis, and Coding (PDAC) contractor website.
Currently there is one product that is coded by CMS as the result of the HCPCS public meeting and final rule implementation, the ReWalk by Argo Technologies.
- L-8701 (powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated) describes a custom fabricated, single or double upright myoelectric elbow, wrist, and hand device. Included in the code is an adjustable microprocessor control feature that utilizes electromyography (EMG) signals. These signals are derived from intact muscle tissue which control the motors and result in support and movement of the limb through functional motion. The custom fabricated device can be constructed from thermosetting materials, thermoplastics, or composite type materials. There are no additional add-on codes for this device. This device is custom fabricated per the DMEPOS Quality Standards, Appendix C.
- L-8702 (powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated) describes a custom fabricated single or double upright myoelectric elbow, wrist, hand, and finger device. Included in the code is an adjustable microprocessor control feature that utilizes EMG signals. These signals are derived from intact muscle tissue which control the motors and result in support and movement of the limb through functional motion. The custom fabricated device can be constructed from thermosetting materials, thermoplastics, or composite type materials. There are no additional add-on codes for this device. This device is custom fabricated per the DMEPOS Quality Standards, Appendix C.
Effective for claims with dates of service on or after June 1, the only products that may be billed using HCPCS codes L-8701 and L-8702 are those that have received mandatory code verification review and are listed on the PCL of the PDAC contractor website.
Currently there are products that are coded by CMS as the result of the HCPCS public meeting and final rule implementation. These products are the MyoPro 2 Motion E and Motion W, which are coded as L-8701, and the MyoPro 2 Motion G which is coded as L-8702.
