Powered Upper Extremity Exoskeleton - Correct Coding - JA DME

Joint DME MAC and PDAC Publication
Posted December 28, 2023

On November 13, 2023 the Centers for Medicare & Medicaid Services (CMS) published final rule CMS-1780-F effective January 1, 2024, that codifies the Medicare definition of a brace to the regulations at 42 CFR 410.2. This rule finalizes 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.

Upper extremity 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.

L8701 (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.

L8702 (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 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.

Effective for claims with dates of service on or after June 1, 2024, the only products that may be billed using Healthcare Common Procedure Coding System (HCPCS) codes L8701 and L8702 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 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 L8701, and the MyoPro 2® Motion G which is coded as L8702.

The CMS Program Integrity Manual (CMS Pub. 100-08), Chapter 3, Sections 3.3.B and 3.6.2.4 specify that for Medicare claims, only CMS and the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have the authority to establish HCPCS Level II Coding Guidelines. Pursuant to 42 CFR § 414.40 and 45 CFR § 162.1002, CMS has the authority to assign and manage HCPCS codes (create, delete, change code narrative, etc.).

Correct coding is an essential element for correct claim payment. To assist manufacturers and suppliers with correct coding, the DME MACs are requiring mandatory code verification review by the PDAC contractor for upper extremity exoskeletal devices that might qualify for HCPCS codes L8701 and L8702. The application for the coding verification review is located on the PDAC website. For questions about correct coding, contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 a.m. to 5:00 p.m. ET, Monday through Friday. You may also visit the PDAC website to chat with a representative, or select the Contact Us website button at the top of the PDAC website for email, FAX, or postal mail information.

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