For prescribing physicians

MyoPro® Prescribing and Documentation

Understand the referral, medical necessity documentation, order form, and fax submission steps needed for a patient who may be appropriate for the MyoPro®.

Submit Documentation via Fax: 857-373-7050 Refer a Patient Online → Contact Myomo Request an In-Service

Clinician working with a person using a MyoPro®

Documentation submission

Submit completed documentation by fax

Once the face-to-face progress note, standard written order, and patient face sheet are complete, submit all documentation by fax.

857-373-7050

Physician workflow

Documentation steps

Complete a face-to-face evaluation

Evaluate the patient for medical necessity for the MyoPro® and document the clinical need in the progress note.

Endorse that the MyoPro® is medically necessary based on your face-to-face evaluation.
Document that previous rehabilitation or treatment has not restored meaningful arm and hand function.
Describe the patient’s need for the MyoPro® to increase independence with ADLs such as dressing, toileting, hygiene, self-feeding, and similar tasks.
Include patient face sheet: Submit patient demographics and insurance information with the face-to-face progress note and order documentation.

Include required clinical findings

The progress note should contain sufficient information to support medical necessity and the patient’s functional need.

Upper-limb weakness or paralysis.
Functional limitations involving the affected arm or hand.
Prior therapy or treatment that has not restored meaningful arm and hand function.
Relevant prior interventions such as PT, OT, bracing, e-stim, Botox, or similar treatments, if applicable.
Why the MyoPro® is medically necessary.
Strength documentation, such as arm weakness grades.
Spasticity level, such as mild, moderate, or severe.
Grossly normal passive range of motion.
Shoulder subluxation documented as none or less than two finger widths.
Pain managed in the upper extremity, if applicable.
Intact cognition and ability to participate in use and training.

Complete the order and documentation forms

Download or open the required form, complete the information, save or print the completed form, and submit it by fax to 857-373-7050.

Do not enter patient information into an unsecured website form. These resources are PDFs, and completed patient documentation should be submitted through the approved fax workflow.

Documentation resources