LaTasha Washington, a 51-year-old T8 paraplegic from Detroit, is taking her first steps in 20 years with the assistance of a battery-powered exoskeleton. “I was interested in trying the exoskeleton for the opportunity to exercise, walk and hopefully improve my bowel program,” says Washington, who sustained her spinal cord injury from a spinal tumor. “My first time in the device, I was really nervous, but once I got into a rhythm, it was great.”

Now, thanks to a new rule by the Centers for Medicare & Medicaid Services, others may have an easier time following in her footsteps.

Moving Out of the Clinic

CMS’ 2024 Home Health Rule that went into effect Jan. 1, 2024, now classifies exoskeletons within the brace benefit category, which is reimbursed by Medicare.

According to CMS, inclusion of exoskeletons in the existing brace category will “expedite coverage and payment for newer technology and powered devices, potentially providing faster access to these new health care technologies for Medicare beneficiaries.”

The robotic braces are worn over a user’s clothing and provide powered motion for hips and knees, enabling those with SCI and other neurological conditions to stand upright and walk. For years, FDA-approved exoskeletons have been around for clinical therapeutic use in rehabilitation centers only.

Washington, who uses the ReWalk Personal 6.0 Exoskeleton, is among the first in the U.S. to have the device covered under Medicare. She completed months of exoskeleton home training recently at DMC Rehabilitation Institute of Michigan and is looking forward to taking her exoskeleton home.

“I am so grateful. I never thought I would be able to afford something like this. Not sitting all the time and being able to walk, it’s been a life-changer, a social changer and an emotional changer,” she says. “I’m excited to take it home and walk up my street for the first time. It’s a new level of independence I’m looking forward to.”

Ekso Bionics’ Indego Personal and ReWalk’s Personal 6.0 Exoskeleton are the only two exoskeletons approved by the FDA for home use. However, with price tags averaging over $100,000, they are cost-prohibitive for the average SCI consumer, making Medicare coverage a huge win. “We are very pleased that CMS recognizes the potential health benefits that exoskeletons can have on the daily lives of individuals with SCI,” says Ekso Bionics president Scott Davis.

While much of the media coverage of exoskeletons has focused on their potential for everyday mobility, research shows that in their current form, exoskeletons may be most functional as an exercise device and for community social interaction. As an exercise device, there is evidence that regular use of an exoskeleton can improve some of the secondary complications of paralysis, including circulation problems, pain, reduced bowel and bladder function, and reduced range of motion.

“This milestone reflects an acknowledgement by Medicare that ReWalk Personal Exoskeleton is a medically necessary device, as supported by a body of scientific evidence, when prescribed for an eligible Medicare beneficiary with SCI,” says Larry Jasinski, CEO of Lifeward, formerly ReWalk Robotics.

Cost

CMS has proposed a payment level of $94,617 for devices in the brace benefit category. The beneficiary is responsible for Medicare’s 20% copay. Washington had a supplemental plan that covered the full copayment. Without additional insurance, a user would be responsible for the remaining out-of-pocket costs.

“We’re prepared to offer our Ekso Indego Personal at the proposed Medicare payment level, so we can get this out to as many folks [as] need it,” says Davis.

Eligibility

Lifeward and Ekso Bionics have similar eligibility requirements for exoskeleton use. Individuals must be paraplegic, over the age of 18, with healthy bone density, good tolerance for standing, and excellent range of motion at the hips, knees and ankles. A medical assessment and radiologic imaging are also required. Eligible candidates must complete 3-6 months of training with a companion at a certified clinical site to learn basic and advanced skills before they can take the exoskeleton home. You can find your nearest training center on the Ekso and Lifeward websites.

How To Get One

Interested in an exoskeleton home unit? The first step is to talk with your physician and see if you meet the eligibility requirements. There is also a lot of great information on the Lifeward and Ekso websites, where you can connect with a care coordinator to walk you through the entire process and answer your questions.