9 commercial payer policies list L8701. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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9 policies from 9 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of L8701 |
|---|---|---|
| Robotic-assisted Rehabilitation of the Extremities | Oct 11, 2023 | Covered |
| Policy | Effective | Status of L8701 |
|---|---|---|
| Durable Medical Equipment and Orthotics and Prosthetics Guidelines | Not recorded | Covered |
| Policy | Effective | Status of L8701 |
|---|---|---|
| Upper Extremity Myoelectric Orthoses | Oct 1, 2026 | Not covered |
| Policy | Effective |
|---|
| Status of L8701 |
|---|
| Myoelectric Prosthetic and Orthotic Components for the Upper Limb | Jun 15, 2026 | Covered |
|---|
| Policy | Effective | Status of L8701 |
|---|---|---|
| Myoelectric Prosthetic and Orthotic Components for the Upper Limb | Jun 15, 2026 | Covered |
| Policy | Effective | Status of L8701 |
|---|---|---|
| Myoelectric Prosthetic and Orthotic Components for the Upper Limb | Jun 15, 2026 | Covered |
| Policy | Effective | Status of L8701 |
|---|---|---|
| Myoelectric Prosthetic and Orthotic Components for the Upper Limb | Jun 15, 2026 | Covered |
| Policy | Effective | Status of L8701 |
|---|---|---|
| Cigna Medicare Advantage Durable Medical Equipment Code List | Jan 1, 2025 | Prior auth required |
| Policy | Effective | Status of L8701 |
|---|---|---|
| Myoelectric and Microprocessor Prosthetic and Orthotic Components for the Upper Limb | Apr 1, 2026 | Covered |