Powered Exoskeleton for Ambulation in Patients With Lower-Limb Disabilities

This policy covers powered lower‑limb exoskeletons for ambulation (external motorized orthoses providing user‑initiated standing, walking, sitting and limited stair modes) for select populations including adults with spinal cord injury (e.g., T7–L5 for supervised community use, T4–T6 limited to rehabilitation institutions), individuals post‑stroke with hemiplegia, and other FDA‑cleared indications (e.g., paraplegia from neuromuscular disease, cerebral palsy), and it recognizes an Illinois statutory mandate requiring coverage for children with low‑tone neuromuscular/neurologic/cognitive impairments in certain fully insured plans effective 2025‑01‑01. Coverage is otherwise highly limited: devices are not covered as experimental only when used within specified FDA‑cleared indications, and candidates must meet strict requirements (trained companion or therapist supervision and certification, user training/assessment, ability to use forearm crutches/walker and perform weight‑shifting, upper extremity strength at least 4/5, height 160–190 cm, weight ≤100 kg, adequate bone health), with many uses restricted to supervised rehabilitation settings.