Robotic Arms

Revised: November 25, 2024

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Authorization

· Billing

· Legal References

Overview

Robotic arms refer to assistive devices that are attached to a member’s power wheelchair and help people with disabilities perform activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Robotic arms may enhance or increase the functional capabilities of people living with heavily limited use of upper extremities.

Eligible Providers

Robotic arm vendors must be enrolled as medical equipment providers. The following are eligible to provide robotic arms:

· Federally qualified health centers

· Home health agencies

· Hospitals

· Indian health services

· Medical suppliers

· Rural health clinics

Eligible Members

Robotic arms are covered for eligible Minnesota Health Care Programs (MHCP) members who suffer from a disability that severely restricts use of their upper extremities.

Potential diagnoses could include (but are not limited to):

· Amyotrophic lateral sclerosis (ALS)

· Arthrogryposis

· Cerebral palsy

· Multiple sclerosis

· Muscular dystrophy

· Parkinson’s disease

· Quadriplegia

· Spinal cord injury

· Spinal muscular atrophy

· Stroke

Covered Services

MHCP covers robotic arms for MHCP members who have a condition that severely restricts use of their upper extremities and meet all of the following criteria:

· The member must be a full-time power wheelchair user; and

· Documentation indicates the member is unable to use both of their upper extremities against gravity, as evident by Manual Muscle Testing; and

· Documentation shows the device will allow the member to be independent in one or more ADLs or IADLs.

· ADLs include but are not limited to bathing, dressing, drinking, eating, hygiene activities and toileting, and other activities specified in the treatment plan.

· IADLs allow an individual to live independently and include but are not limited to accessing public transportation, food preparation, housekeeping, opening doors, shopping, and taking medication.

Noncovered Services

MHCP does not cover robotic arms that are not registered with the U.S. Food and Drug Administration.

Refer to information under the Noncovered Services heading in the Billing the Member (Recipient) section of the MHCP Provider Manual to review the conditions required to bill the member.

Authorization

Prior authorization is required for all robotic arms. Submit authorization requests and required documentation to the Medical Review Agent. Requests for coverage are reviewed according to procedures for reviewing durable medical equipment (DME) requests. Coverage determinations are based upon a review of submitted case-specific information.

Documentation for authorization requests must include:

· Member’s diagnosis and clinical history

· Order

· Letter of medical necessity

· A face-to-face evaluation by a physical or occupational therapist

· Results of device trial period including links to unedited trial videos of the member completing ADLs or other desired IADLs

· Consideration of less-costly alternatives to robotic arms including documentation stating why alternative devices are not appropriate for member’s condition and medical needs

· A detailed list of products and accessories including manufacturer, model number, product description, and manufacturer’s suggested retail price (MSRP)

The provider must appropriately train the member on the use of the equipment, including any necessary adjustments. These costs are not separately reimbursable.

MHCP policy requires a three-month trial before purchase. Authorization is required for purchase of the device. Trial periods must be initiated before requesting authorization and payment will only be provided upon the successful completion of the trial period. The review process is as follows:

· The provider and medical supplier evaluate the member’s medical needs, attach the device to the member’s power wheelchair, and provide necessary training and adjustments.

· The member uses the device in their usual living arrangement.

· During the three-month trial period, a request for purchase of the device must be submitted along with documentation from a physician or therapist illustrating ongoing, safe use of the device. Note:

· Requests for purchase may be submitted four weeks into the trial period or later, however, purchase will only be effective after completion of the full three-month trial.

· If during the trial period the member does not wish to convert the robotic arm to a purchase, the device must be detached and returned to the provider.

· MHCP receives and reviews request for robotic arm according to procedures for reviewing DME.

· If the robotic arm is approved, the device becomes the member’s property.

If a robotic arm is approved for a member, the provider must obtain documentation from the member or the member’s authorized representative acknowledging that the member understands the robotic arm may affect future requests for PCA or home care services before dispensing and billing for this item. The documentation must be made available to the Minnesota Department of Human Services (DHS) or its authorized agent upon request.

Billing

Providers are responsible to coordinate services. Refer to the Billing Policy Overview section of the MHCP Provider Manual for general billing information.

Bill robotic arms using MN–ITS 837P Professional. Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetics, Orthotics, and Augmentative Devices MN–ITS user manual for general billing requirements and guidance when submitting claims.

· Bill using HCPCS code E1399 for robotic arms and K0108 for accessories that do not have a more appropriate HCPCS code.

· Use modifier U9 with E1399.

· Use modifier NU for purchases.

· Use modifier RR for rentals.

· Do not bill MHCP for repairs when the device is under warranty.

· If the member has Medicare or other insurance coverage as primary, include documentation with the request demonstrating the device is a noncovered item by the primary insurance.

Robotic arms have a warranty period in which the manufacturer is to pay for maintenance and repair. MHCP will only reimburse for one month of rental while a device is being repaired.

When adding a robotic arm to an existing mobility device, the provider is responsible for the replacement of the joystick and interface controls or electronics needed for the operation of the robotic arm.

Legal References

Minnesota Statutes, 256B.0625, subdivision 31 (Covered Services)
Code of Federal Regulations, title 21, section 890.3420 (a)(b)