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Click here to view the medical policy for continuous passive motion devices (CPMD). Benefits for additional procedures other than those listed will be considered on an individual case basis with documentation of meeting medical criteria for coverage.
CPMDs include required exercise software supplies (i.e., lamb's wool padding, straps, etc.).
For Total Knee Replacement
A CPMD is eligible for coverage for total knee replacement as long as the device was started on the patient within two days after the surgery. In addition, coverage for use of the device is limited to a six-week period following discharge from the hospital after the surgery.
A CPMD may be covered for post-operative care for the following surgeries:
For Shoulder Indications
Benefits may be provided for CPMD for six weeks after the following shoulder surgeries:
Other uses may be considered on an individual case basis with documentation of medical necessity. Claims for use of the device for longer than a six-week period must be reviewed for medical necessity.
Cervical Head Harness/Halter
A cervical head harness/halter is included in the global fee for traction.
A pelvic belt, harness or boot is included in the global fee for traction.
Last Updated July 2010