Will insurance, Medicare, HSA or FSA pay for an exoskeleton?

Medicare and the K1007 code

CMS created HCPCS code K1007, a powered bilateral hip, knee, ankle and foot device, effective October 1, 2020, to describe the ReWalk Personal Prosthetic Exoskeleton System. ReWalk is used by people with lower-body paralysis from spinal cord injury at levels T7 to L5, and must be used with a specially trained companion. CMS classed ReWalk as a leg brace and set a 2024 Medicare purchase fee schedule amount of $91,031.93 for K1007^[1].

Consumer exoskeletons such as Hypershell’s and Dnsys’s are a different kind of product. They are sold online, worn at the hip or knees, and described by their makers as not medical devices^{[2, 3]}. We found no Medicare code or coverage decision for them in the CMS document above or on the brands’ pages.

HSA and FSA

IRS Publication 502 defines medical expenses as the costs of “diagnosis, cure, mitigation, treatment, or prevention of disease”, and says they don’t include expenses that are merely beneficial to general health. An item ordinarily used for personal purposes doesn’t count unless it is used primarily for a medical purpose. The publication doesn’t mention exoskeletons^[4].

Neither Hypershell nor Dnsys says on the pages we read that its exoskeletons qualify for HSA or FSA funds. Hypershell says its product is not FDA-approved or classified as a medical device^[2]. Ask your HSA or FSA administrator before you buy.

Private insurance

We haven’t reviewed private insurance policies. If you ask an insurer, mention that the manufacturer describes the device as not a medical device.

The UK, Canada and Australia

We haven’t checked public health or insurance rules for these devices in the UK, Canada or Australia.