![]() This can be done by means of serial neurological examinations over a period of 3 to 6 months, which fail to show progression of signs and symptoms referable to the area of injury or imaging of the spine that excludes the presence of a progressive lesion. It is also recommended that neurological stability be established. ![]() Medically, these patients have injuries at the C5 and/or C6 level. The patient must have adequate range of motion with forearm and hand muscles that respond to stimulation with electrical impulses. The palmar prehension grasp is designed to help people hold and release a large object, such as a cup, ball, or book.Īppropriate candidates for the NeuroControl Freehand System must have use of their shoulder, upper arm, and elbow they may or may not have use of their wrist, and limited use of their hands. The lateral prehension grasp (key pinch) is designed to help with activities such as writing, editing, and grasping small objects. The NeuroControl Freehand System allows for 2 different hand grasp positions. When the patient elevates and depresses or protracts and retracts this shoulder the movement is relayed to the control box, which is programmed to coordinate the activity in the electrodes and cause the hand to open and close. A movement detector is placed externally on the opposite shoulder. The electrode wires are tunneled up the arm to a control box located under the skin in the pectoral region. The NeuroControl Freehand System involves transfers of multiple tendons together with the implantation of up to eight electrodes in the muscles of the forearm and hand of patients with quadriplegia (Johnson and Whitworth, 2002). The NeuroControl Freehand System is a surgically implanted device that restores hand function in people with quadriplegia by neuroelectric stimulation of forearm and hand muscles. ICD-10 codes covered if selection criteria are met: Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extensionĮxternal recharging system for battery (internal) for use with implantable neurostimulatorĮxternal recharging system for battery (external) for use with implantable neurostimulator Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension Implantable neurostimulator pulse generator, single array, rechargeable, includes extension Implantable neurostimulator radiofrequency receiver Implantable neurostimulator electrode, each Generator, neurostimulator (implantable), non-rechargeable ![]() HCPCS codes covered if selection criteria are met: Codes requiring a 7th character are represented by "+":ĬPT codes covered if selection criteria are met: Information in the below has been added for clarification purposes. Table: CPT Codes / HCPCS Codes / ICD-10 Codes Code Neurological stability is established by means of serial neurological examinations over a period of 3 to 6 months that do not show progression of signs and symptoms referable to the area of injury, or serial imaging of the spine that excludes the presence of a progressive lesion.Īetna considers the NeuroControl Freehand System for members not meeting the aforementioned criteria experimental and investigational.Member must have adequate range of motion with forearm and hand muscles that respond to stimulation with electrical impulses and.Member must have use of their shoulder, upper arm and elbow and.Medical NecessityĪetna considers the NeuroControl Freehand System medically necessary for members with paralyzed hand(s) who meet all of the following criteria: ![]() This Clinical Policy Bulletin addresses NeuroControl freehand system. Number: 0378 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References ![]()
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