OR-PR.00005 Upper Extremity Myoelectric Orthoses

This policy addresses upper extremity myoelectric orthoses (for example, the MyoPro) that use muscle signals and motors to assist arm movement. Anthem deems these devices investigational/experimental and not medically necessary; therefore, they are not covered for any indication, including use after stroke, trauma, or with neurological disorders. There are no covered indications or exceptions under this policy; related codes include L3999, L8701, and L8702.

"The use of myoelectric upper extremity orthotic devices is consideredinvestigational and not medically necessaryfor all indications, including but not limited to use by individuals with stroke, tra..."

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