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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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