E1832, Static progressive stretch finger device, extension and/or flexion, with or
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage but does not guarantee coverage.
- Clinical documentation from physician or therapist stating limited range of motion causes a meaningful functional limitation.
- Documentation of injury or operation date to verify the ≥3 weeks and ≤4 months timeframe.
- Records showing prior interventions (e.g., physical therapy) and documentation that the member did not respond.
Key Coverage Criteria
- Prevention and treatment of joint contractures of the extremities to maintain or restore range of motion (ROM).
- Use of mechanical stretching devices for extension or flexion of shoulder, elbow, wrist, fingers, knee, ankle, and toes as an adjunct to physical therapy and/or exercise.
- Use of LLPS/dynamic stretch device for toe, knee, elbow, wrist, ankle, or finger in the subacute injury or post‑operative period (≥3 weeks and ≤4 months after injury or operation) for members with persistent joint stiffness or contracture.
- Limited range of motion must pose a meaningful functional limitation as determined by the physician or therapist, the condition has not responded to other interventions (including physical therapy), and the device is provided as adjunctive treatment (e.g., home exercise program, physical therapy).
- Rental of device in the acute post‑operative period for members who have undergone additional surgery to improve range of motion of the previously affected joint.
- Initial rental period of up to four weeks for the above post‑operative indication.
5 Active Policies
ANTHEM-DME.00038, DME.00038 Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices
UHC-POL-mechanical-stretching-devices, Mechanical Stretching Devices
AMBETTER-CP.MP.144, Mechanical Stretching Devices for Joint Stiffness and Contracture
UMR-POL-UMR-mechanical-stretching-devices, Mechanical Stretching Devices
Related Codes
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