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May 19, 2016

Powered Exoskeleton Products - Correct Coding

DME MAC Joint Publication

Recently several products described as powered exoskeletons have been developed. These items are reported to support mobility for spinal cord injured beneficiaries who are unable to ambulate. These products are principally provided for supervised use in rehabilitation settings. Currently there are two FDA-approved products, Rewalk™ (Argo Technologies) and Indego® (Parker Hannifin Corp.). Other similar products are in development but are not yet on the market in the United States. These devices provide a powered lower limb exoskeleton enabling beneficiaries who are non-ambulatory due to spinal cord injuries to ambulate with the assistance of a cane, crutches or a walker under direct supervision and thus participate in over-ground gait training.

Although these products resemble "orthoses", for Medicare HCPCS coding purposes, brace-like products that exert a powered force across a joint are not coded as orthoses with HCPCS "L" codes but rather are coded using other HCPCS codes. Equipment used in institutional rehabilitation settings is statutorily excluded from reimbursement under the DME benefit. Claims submitted to the DME MACs for a powered exoskeleton must use HCPCS code:

A9270 - NON-COVERED ITEM OR SERVICE

This code describes the entire product provided at initial issue. A complete, functional product must be provided at initial issue. Use of other HCPCS codes to bill for the entire items or for separate components, options, accessories and/or supplies is considered incorrect coding.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) contractor Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4 p.m. CT, Monday through Friday, or e-mail the PDAC.

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