Continuous Passive Motion and Mechanical Stretching Devices - MEDICAID - OKLAHOMA

This policy addresses continuous passive motion (CPM) devices and mechanical stretching devices (including static‑progressive and progressive stretch systems and related orthoses) intended to restore joint range of motion or assist postoperative recovery for knee, shoulder, elbow, wrist, ankle and other joint contractures. However, the Plan considers CPM (including HCPCS E0935/E0936) and mechanical stretching devices not medically necessary/not eligible for ANY indication (with CPM explicitly excluded for shoulder articular injuries and for total/revision knee arthroplasty), and lists numerous device models and HCPCS codes (eg, E1800–E1841, L4396) and specific brands as experimental/investigational or excluded.

"Mechanical stretching devices differ from CPM devices in that they are nonmotorized."

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