E1832 — Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories
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 of the service requested; refer to the protocol titled 'Medical Records Documentation Used for Reviews.'
- Benefit coverage is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service; when deciding coverage, the member specific benefit plan document must be referenced as plan terms may differ from the standard plan.
- 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.
Key Coverage Criteria
- Low-load prolonged-duration stretch devices (LLPS) as an adjunct to therapy are proven and medically necessary for treating existing joint contractures of the upper and lower extremities.
- LLPS (dynamic splinting) devices to relieve persistent joint stiffness that can occur after injury or surgery.
- Use of dynamic LLPS devices for restoration of joint range of motion (ROM) for joints including (but not necessarily limited to) finger, wrist, elbow, knee, and toe where evidence supports benefit.
- Custom dynamic splinting systems when effective treatment cannot be provided with prefabricated units (e.g., limb size/shape or necessary load/material requirements).
- 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.
5 Active Policies
AMBETTER-CP.MP.144 — Mechanical Stretching Devices for Joint Stiffness and Contracture
ANTHEM-DME.00038 — DME.00038 Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices
UHC-POL-mechanical-stretching-devices — Mechanical Stretching Devices
UMR-POL-UMR-mechanical-stretching-devices — Mechanical Stretching Devices
Related Codes
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