Mechanical Stretching Devices for Contracture and Joint Stiffness

Covered: dynamic splinting devices as DME for the knee, elbow, wrist, finger, or toe (and adjustable ankle extension/flexion devices per CPB 0565) when used as an adjunct to occupational/physical therapy with documented significant motion loss/stiffness in the sub‑acute period (≥3 weeks post‑injury/surgery) or in the acute post‑op period after a second/subsequent surgery, billed to applicable CPT/HCPCS codes (e.g., 29126, 29131, 29505, 29515; E1800–E1831). Excluded: use for many conditions (e.g., carpal tunnel, cerebral palsy, stroke, MS, muscular dystrophy, RA, plantar fasciitis, ankle/shoulder injuries, trismus), prophylactic/chronic use without improvement, PASS devices, most JAS splints and specific JAS uses (including EZ Turnbuckle after ORIF for radial head) are considered experimental/investigational.

"Use of the EZ Turnbuckle orthosis (JAS orthosis) after open reduction internal fixation (ORIF) for radial head fracture is considered experimental and investigational."