Continuous Passive Motion in the Home Setting

This policy covers home use of continuous passive motion (CPM) devices as an adjunct to physical therapy for specified indications, including children with clinical or genetic diagnoses causing low‑tone neuromuscular, neurological, or cognitive impairment and certain postoperative indications—most prominently total knee arthroplasty/revision when active rehabilitation cannot be performed and non–weight‑bearing knee articular cartilage repairs. Coverage is limited to home use, excludes routine postoperative CPM when the patient can participate in active therapy, restricts home CPM after TKA to immobile/non–weight‑bearing patients for up to 17 days (with general durations up to 6 weeks for covered uses), considers other joint or non‑specified uses investigational, and is subject to Illinois Public Act applicability (does not mandate self‑funded/ERISA plans).

"Coverage for therapy, diagnostic testing, and equipment necessary to increase quality of life for children clinically or genetically diagnosed with any disease, syndrome, or disorder that includes ..."