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 calendar 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 calendar 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 calendar 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.