AutoMove AM800

POLICY NUMBER

L.2.01.401

DESCRIPTION

Imagination is behind the NeuroMove^TM (formerly the AM800). The NeuroMove^TM uses the patient's powers of concentration and imagination to help relearn muscle movements which have been lost.

The NeuroMove^TM uses three (3) sensors and is used one to three times a day in intervals of approximately 20 minutes. Once in place, the electrodes detect electrical signals sent from the brain to nerves inside the muscle. This electrical activity registers on the NeuroMove's^TM display screen and the less activity there is in a muscle, the harder it is to move that muscle. Increasing the electrical activity requires reteaching the brain to send messages to the effected muscle. This is where imagination and concentration help out. By simply thinking about moving a muscle, a person raises the electrical activity present in that muscle.

The computer inside the NeuroMove^TM evaluates the amount of activity present in the muscle, then sets a higher standard that the patient should try to reach as he or she concentrates. If the patient reaches this mark (threshold) he or she is rewarded with an electrical impulse that makes the muscle move for a few seconds. Success is measured in the actual movement of a hand, arm etc. and gives the patient greater control over his/her extremity.

POLICY

NeuroMove^TM is a biofeedback modality and considered investigational.

POLICY EXCEPTIONS

None

POLICY GUIDELINES

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.

POLICY HISTORY

11/2001: Approved by Medical Policy Advisory Committee (MPAC)

2/14/2002: Investigational definition added

4/18/2002: Type of Service and Place of Service deleted

10/14/2004: Code Reference section completed, non-covered table added, HCPCS E1399 added

09/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy

10/10/2006: Policy reviewed, no changes

1/7/2009: Policy reviewed, NeuroMove^TM inserted for the "AutoMove AM800."

05/06/2013: Policy reviewed; no changes.

07/06/2015: Code Reference section updated for ICD-10.

06/06/2016: Policy number L.2.01.401 added. Investigative definition updated in Policy Guidelines section.

10/07/2022: Policy reviewed; no changes.

08/21/2023: Policy reviewed; no changes.

08/28/2024: Policy reviewed; no changes.

SOURCE(S)

1. Stroke Recovery Systems, Inc.

2. Zynex Medical®

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.

Investigational Codes

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