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CommercialCoverageMedium impact

Continuous Passive Motion in the Home Setting

Blue Cross & Blue Shield of Mississippi·MS · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply

Summary

This policy establishes coverage criteria for continuous passive motion (CPM) devices in home settings for BCBS Mississippi members. CPM is considered medically necessary only as an adjunct to physical therapy for specific post-surgical knee conditions including total knee arthroplasty with complications and during non-weight bearing rehabilitation after knee cartilage repair procedures.

Action Required

Action needed
Immediately: Billing team must verify CPM device claims (HCPCS E0936) include proper documentation showing medical necessity as adjunct to physical therapy for covered knee conditions only. Ensure claims for other joints or conditions are not submitted as they are considered investigational. Update prior authorization processes to require documentation of low postoperative mobility, inability to comply with rehabilitation, or non-weight bearing rehabilitation period following knee cartilage repair.

Affected Billing Codes

V43.65
E0936
24360
24363
27407
27409
27447
27486
27487
97110