Powered Exoskeleton Orthosis (DME)
Customize your policy alerts
Sign up for all northwood policy alerts
Know when northwood releases new policies or updates existing guidance.
Monitor payer policy activity
This policy governs coverage and coding for powered exoskeleton orthoses used to provide powered hip and knee motion for ambulation (e.g., for spinal cord injury) and applies to Northwood's benefit determinations for DMEPOS.
No material clinical or coverage changes in this revision.
Coverage criteria and policy stance
Coverage and Medical Necessity
Policy stance and general medical necessity framing
Examples include ReWalk Personal System.
Certain statutory or regulatory requirements may affect coverage; final determinations are contract-dependent.
Manufacturer and FDA trial selection criteria apply.
Equipment that is used primarily and customarily for a non‑medical purpose is not considered durable medical equipment and is excluded from DMEPOS coverage. Coverage determinations are made on a case‑by‑case basis and remain subject to the member's contract, including the plan’s definitions of medical necessity, limitations, and exclusions.
A powered exoskeleton device is considered experimental, investigational, or unproven (for example, the ReWalk Personal System) and therefore is not covered as medically necessary under this policy.
HCPCS and related codes
| K1007 | Bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors (Code effective 10/1/20). |
| K1007 | Bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors (Code effective 10/1/20). |
Prior authorization, documentation, and provider requirements
Submit prior authorization with clinical justification and rehabilitation plan
Prior authorization is required for claims billed with HCPCS K1007. The prior authorization request must include clinical justification that the device meets the benefit category and is reasonable and necessary per the carrier/plan sponsor, and must document the planned coordinated and structured rehabilitation and the trained personnel who will provide device training.
- Include clinical justification that K1007 meets a defined DMEPOS benefit category and is reasonable and necessary for the enrollee per carrier/plan sponsor criteria.
- Document the planned coordinated and structured rehabilitation program prior to and during home use and identify the skilled, licensed physical therapist and dedicated caregiver who will provide training.
No step therapy requirements specified
There are no step therapy requirements specified in this policy for powered exoskeleton devices or HCPCS K1007.
Include required clinical and administrative documentation for authorization
Provide comprehensive clinical and administrative documentation with authorization and any coverage review: diagnosis, justification that the device meets benefit category and reasonable and necessary criteria, and evidence of a planned, coordinated and structured rehabilitation program.
- Clinical documentation of the diagnosis and justification that the device meets reasonable and necessary criteria per carrier/plan sponsor.
- Evidence of a planned coordinated and structured rehabilitation program prior to and during home use.
- Identification of the skilled licensed physical therapist trained for device use and the dedicated caregiver who will assist the patient.
- Proof of access to an appropriate rehabilitation facility that offers the device program.
- Note that DMEPOS items must meet benefit category and reasonable and necessary criteria as defined by the carrier/plan sponsor and member contract.
Devices considered experimental/investigational will not be covered
Powered exoskeleton devices (e.g., ReWalk) are classified as experimental, investigational, or unproven; devices determined to be experimental/investigational are not covered and will trigger denial/noncoverage.
- If the device is considered experimental, investigational or unproven, coverage will be denied/noncovered under this policy.
Medical necessity considerations
DME Medical Necessity Considerations
General conditions referenced for consideration (policy nonetheless deems devices experimental):
Supported by FDA device descriptions; examples include trunk-hip-knee-ankle-foot systems.
Training is lengthy and extends over weeks to months.
Contract language and any applicable statutory/regulatory requirements prevail.
This documentation supports prior authorization and benefit determination.
Rental, purchase, and payment rules
| Item | Rental vs Purchase Guidance | Contract-dependent determination |
|---|---|---|
| K1007 — Powered exoskeleton (Bilateral hip, knee, ankle, foot device, powered; includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors) | ||
| Not specified in policy; device coding is defined but the policy classifies powered exoskeletons as experimental, investigational, or unproven, so routine rental or purchase coverage is not established here. | ||
| Determination of rental versus purchase and any coverage eligibility must follow the member’s contract and the carrier/plan sponsor’s indications and limitations of coverage/medical necessity; benefit category and reasonable and necessary rules apply. |
Key definitions
Background and device description
A powered exoskeleton orthosis is a wearable, motorized external orthotic system that provides powered hip and knee motion to enable standing and ambulation for individuals with spinal cord injury or other lower‑limb impairments. These devices typically incorporate motors, microprocessors, and sensors and are activated by user controls; their safe and effective use generally requires extensive, coordinated training and a structured rehabilitation program led by a skilled licensed physical therapist and support from a dedicated caregiver, often over weeks to months.
Replacement and spare parts
Required documentation for requests
Clinical documentation: diagnosis, N/N justification, structured rehab plan, trained therapist and caregiver, rehab facility access
Include in the record: diagnosis and explicit justification that the device meets reasonable and necessary criteria; a documented, structured rehabilitation plan; named licensed physical therapist trained for the device; identification of a dedicated caregiver; and evidence of access to an appropriate rehabilitation facility.
- Diagnosis and clinical justification that device use is medically necessary and meets benefit criteria.
- Planned coordinated and structured rehabilitation program (prior to and during home use).
- Name and licensure of the skilled physical therapist who will conduct device training.
- Identification of the dedicated caregiver who will assist the patient.
- Proof of access to a facility offering the required rehabilitation program.
Not covered items
Powered exoskeleton devices are considered experimental, investigational, or unproven and are therefore listed as not covered under this policy.
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.