BlueCross BlueShield of Tennessee Medical Policy Manual

Myoelectric Prosthetic Components for the Upper Limb

DESCRIPTION

Myoelectric prostheses are powered by electric motors with an external power source. The joint movement of an upper limb prosthesis (e.g., hand, wrist, and/or elbow) is driven by microchip-processed electrical activity in the muscles of the remaining limb stump.

Upper limb prostheses are used for amputations at any level from the hand to the shoulder. The need for a prosthesis can occur for a number of reasons, including trauma, surgery, or congenital anomalies. The primary goals of the upper limb prosthesis are to restore natural appearance and function. Achieving these goals also requires sufficient comfort and ease of use for continued acceptance by the wearer. The difficulty of achieving these diverse goals with an upper limb prosthesis increases as the level of amputation (digits, hand, wrist, elbow, and shoulder), and thus the complexity of joint movement, increases.

Upper limb prostheses are classified into three categories depending on the means of generating movement at the joints: passive, body-powered, and electrically powered movement. All three types of prostheses have been in use for over 30 years; each possesses unique advantages and disadvantages.

Technology in this area is rapidly changing, driven by advances in biomedical engineering and by the U.S. Department of Defense Advanced Research Projects Agency (DARPA), which is funding a public and private collaborative effort on prosthetic research and development. Areas of development include the use of skin-like silicone elastomer gloves, “artificial muscles,” and sensory feedback. Smaller motors, microcontrollers, implantable myoelectric sensors, and re-innervation of remaining muscle fibers are being developed to allow fine movement control. Lighter batteries and newer materials are being incorporated into myoelectric prostheses to improve comfort.

Examples of myoelectric devices include the Otto Bock myoelectric prosthesis (Otto Bock), the LTI Boston Digital Arm™ System (Liberating Technologies Inc.), and the Utah Arm Systems (Motion Control).  Manufacturers must register prostheses with the restorative devices branch of the U.S. Food and Drug Administration (FDA) and keep a record of any complaints, but do not have to undergo a full FDA review.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDER

We develop Medical Policies to provide guidance to Members and Providers.  This Medical Policy relates only to the services or supplies described in it.  The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy.  For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member’s health plan must be reviewed.  If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.

ADDITIONAL INFORMATION   

Amputees should be evaluated by an independent qualified professional to determine the most appropriate prosthetic components and control mechanism. Typically, this assessment is by a certified orthotist and/or prosthetist who is a healthcare professional specifically educated and trained to manage comprehensive orthotic and/or prosthetic patient care. This includes patient assessment, formulation of a treatment plan, implementation of the treatment plan, follow-up and practice management.  

For individuals in whom the potential benefits of myoelectric prosthetic components for the upper limb are uncertain, individuals may first be fitted with a standard prosthesis to determine their level of function with the standard device.

SOURCES  

BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2010). Myoelectric prosthesis for the upper limb (1.04.04). Retrieved May 17, 2010 from BlueWeb. (9 articles and/or guidelines reviewed)

Egermann, M., Kasten, P., & Thomsen, M. (2009). Myoelectric hand prostheses in very young children. International Orthopaedics, 33 (4), 1101-1105.

Lindner, H., Linacre, J., & Norling, Hermansson L. (2009). Assessment of capacity for myoelectric control: Evaluation of construct and rating scale. Journal of Rehabilitation Medicine, 41(6), 467-474.

ORIGINAL EFFECTIVE DATE:  11/13/2010  

MOST RECENT REVIEW DATE:  11/13/2010

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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