Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut DME.00044 Robotic Arm Assistive Devices Form

Effective Date

09/27/2023

Last Reviewed

08/10/2023

Original Document

  Reference



This document addresses the use of a robotic arm that is mounted to a wheelchair or located on another surface such as a table and is intended to assist individuals with upper extremity disability and mobility limitations due to neurologic conditions, trauma, or other problems.

This document does not address the use of devices worn by the individual (see OR-PR.00005 Upper Extremity Myoelectric Orthoses).

Note: Please see the following related documents for additional information:

  • CG-DME-10 Durable Medical Equipment
  • CG-DME-34 Wheeled Mobility Devices: Wheelchair Accessories
  • OR-PR.00005 Upper Extremity Myoelectric Orthoses

Position Statement

Investigational and Not Medically Necessary:

The use of a robotic feeding assistive device or wheelchair mounted robotic arm is considered investigational and not medically necessary for all indications.