Funding Guide

Is the TEK RMD covered by insurance?

The short answer: sometimes — and the funding landscape improved significantly in 2024. Here is how TEK RMD funding actually works, payer by payer, and what your file usually needs before any reviewer says yes.

The 2024 milestone: a HCPCS code

In September 2024, the Centers for Medicare & Medicaid Services granted the TEK RMD its own HCPCS code — the billing code system insurers use to identify durable medical equipment. Before that, the TEK RMD had to be submitted as miscellaneous equipment, which made every claim an uphill argument. With a dedicated code, reviewers can identify exactly what is being requested, which streamlines prior authorization and appeals.

A code is not a guarantee of payment. It means the device is recognized — each payer still decides coverage under its own medical policy.

Payer by payer

Veterans Affairs (VA)

The VA has covered the TEK RMD for eligible veterans, and Matia Mobility identifies the VA as an established funding path. If you or the user is a veteran enrolled in VA health care, this is usually the strongest route — talk to the VA physical medicine and rehabilitation team or prosthetics department.

Workers’ compensation

When a spinal cord injury or walking disability results from a workplace accident, workers’ compensation carriers have funded the TEK RMD as part of the injured worker’s equipment plan. These cases are handled individually with the adjuster and treating physician.

Commercial insurance, Medicare, and Medicaid

Coverage here varies by plan, state, and individual circumstances. Some private plans and, in some cases, Medicare and Medicaid have approved the device — typically after prior authorization supported by strong clinical documentation. No outcome is guaranteed, and a denial at first review is common for newer device categories; appeals with added documentation are a normal part of the process.

What a funding request usually needs

• A physician’s evaluation and prescription — the TEK RMD is a prescription device, so a treating physician must document why it is medically appropriate for the specific user.
• Medical necessity documentation— diagnosis, functional limitations, why standard equipment does not meet the user’s needs, and the clinical goals of a standing program as determined by the clinician.
• Candidacy confirmation — payers want to see the user fits the device (see who can use the TEK RMD).
• Prior authorization — submitted before delivery for most commercial, Medicare Advantage, and Medicaid plans. Note that an authorization is a review decision, not a promise of payment.

If insurance says no

Financing programs exist for self-funded purchases, and Matia Mobility lists financing partners on its site. Denials can also be appealed — often successfully when the clinical file is strengthened. The right first step either way is the same: get the clinical picture and the paperwork organized.

That is where we come in. StrykeFox Medical works with patients, physicians, and payers on durable medical equipment every day. Send us your information and we will contact you to talk through the funding paths that fit your situation.

This guide is general information, not medical or insurance advice. Device suitability is determined by your physician, and insurance coverage is determined by your individual plan. Specifications referenced are published by Matia Mobility and may change.