Prescribing Information

For any DMEPOS items to be covered by insurance, the patient’s medical record must contain sufficient information about the patient’s medical condition to substantiate medical necessity for the product.

Step 1:

Evaluate your patient during a face-to-face visit for medical necessity for the MyoPro. A progress note documenting medical necessity for the MyoPro is required to move forward.

Progress Note Requirements:

• Endorsement that the MyoPro is medically necessary for patient based on your face-to-face evaluation
• Previous rehabilitation treatment (e.g., PT, OT, bracing, e-stim, Botox) has not restored meaningful arm function
• Patient needs the MyoPro to increase independence with ADLs (dressing, toileting, hygiene, self-feeding, etc.)

Supplemental Documentation in Physical Exam:

• Documentation of arm weakness (e.g., strength grades: 1/5, 2/5)
• Spasticity (mild, moderate, severe)
• Grossly normal passive range of motion
• Shoulder subluxation: None or less than 2 finger widths
• Pain managed in upper extremity (if applicable)
• Intact cognition

Step 2:

Complete and sign Standard Written Order.