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TRICARE Policy Manual 6010.60-M, April 1, 2015
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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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