Other Services
Chapter 8
Section 18.1
Continuous Passive Motion (CPM) Devices
Issue Date: January
26, 1987
Revision:
1.0 HCPCS Procedure
Codes
Level II Code E0935 and E0936.
2.0
POLICY
CPM
devices are covered as Durable Medical Equipment (DME) for patients
receiving therapy for joints that are replaced, traumatized, infected,
operated upon, and when used following extensive burns involving
one or more kinetic areas.
3.0 Policy Considerations
3.1 Use
of CPM in the patient’s home must begin within two days following
surgery, assuming the patient was discharged within that time frame.
For other conditions identified under
paragraph 2.0, CPM must begin
within two days of stabilization of the patient’s condition that
led to the need for CPM. If CPM was being used in the hospital immediately
prior to discharge either following surgery or for other conditions
identified above, continuity may be maintained at home not to exceed
a combined total of three continuous weeks (hospital and home).
3.2 Use
of CPM following removal of an orthopedic cast or splint is approved
if the cast or splint was applied following surgery. As in
paragraph 3.1,
CPM must begin within two days of removal of the cast or splint
and reimbursement will not exceed three continuous weeks.
3.3 Evidence has
shown that maximum benefits from CPM are derived within the limits
stated in
paragraphs 3.1 and
3.2.
4.0 Effective
Dates
4.1 January
26, 1987, as therapy following total knee replacement.
4.2 October 6, 1988,
as therapy following any joint replacement.
4.3 September 11,
1989, as therapy for joints that are traumatized, infected, operated
upon, and when used following extensive burns, involving one or
more kinetic areas.
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