Continuous Passive Motion (CPM) Devices - DME.MU.201.A

Continuous Passive Motion (CPM) devices (HCPCS E0935 knee, E0936 other upper‑extremity joints) are covered only for post‑operative use to improve range of motion and are not medically necessary for all other indications; Bluetooth accessory devices that augment home therapy do not qualify as DME. Coverage requires documentation of surgery on the target joint, inability to perform active physical therapy or a medical/surgical complication preventing early mobilization, initiation within 2 days of surgery, and use limited to a maximum of 21 days.

"The individual will start using the passive motion device no more than two days after the surgery."

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