Appeal type: Experimental/Investigational
Decision: Overturned

Diagnosis: Left upper extremity hemiparesis.

Treatment: 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.

The insurer denied coverage for 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.

The denial is overturned.

This review is regarding a patient with a history of stroke and seizure with subsequent left upper extremity partial paralysis. The treating physician prescribed the MyoPro device with the indication that because the patient had failed to respond significantly to physical therapy, Occupational Therapy, and Botox injections, he was a prime candidate for the use of this device. 

The scientific evidence in peer-reviewed literature supports a result of improvement in health outcome.

The 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 has final approval from the appropriate regulatory bodies for this diagnosis.

This patient is a good candidate for 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.

The 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 is the best available treatment for this patient at this time.

The adverse risks are not increased over standard treatment/services.

The requested service is likely to be more beneficial than any of the standard treatments/procedures for this patient.

Literature states that in contrast to prosthetic technologies that completely replace limbs, the goal with orthotics, exoskeleton's, and musculatures is to assist (in a sense of assistance with activities of daily life), help regain (as part of rehabilitation treatment), and protect or augment the functionalities of existing limbs. To date, the only commercially available assistive device that allows the user to be untethered and perform day-to-day tasks is the MyoPro Motion (Myomo, Inc.). This device includes multiple joints (elbow, wrist, and hand) and one grasp pattern (tripod) and is marketed as a powered upper limb orthosis, rather than a dedicated hand exoskeleton. Several studies have shown that this type of microprocessor device has helped those individuals such as the patient in question regain functionality and limbs that would have otherwise failed to improve with traditional treatment measures. 

This patient was left with upper extremity partial paralysis and tried and failed physical therapy, Occupational Therapy, and Botox injections. He did well during the evaluation using the MyoPro. Given these findings and based on peer-reviewed literature identifying the benefits with the use of this equipment, and with little to no other treatment options available for the patient, proceeding with this device is approved.

The denial of  coverage for the requested treatment should be overturned. This treatment is likely to be more beneficial than any standard treatments for this patient's condition and the adverse risks are not substantially increased over standard treatments.