DME.00038 Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices

This policy addresses static progressive stretch (SPS) and patient‑actuated serial stretch (PASS) devices used to improve range of motion in joint contractures. Anthem considers both SPS and PASS devices investigational and not medically necessary; therefore, they are not covered for any indication. No exceptions are noted, and related claims (e.g., HCPCS E1399, E1801, E1806, E1811, E1816, E1818, E1821, E1831, E1832, E1841) would be denied.

"Static progressive stretch (SPS) devices are consideredinvestigational and not medically necessary."

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