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Continuous Passive Motion Devices

According to the  CMS Internet-Only Manual Publication 100-03, National Coverage Determination (NCD) Manual, CPM devices are covered for patients who have received a total knee replacement. To qualify for coverage, use must commence within two days following surgery. In addition, coverage is limited to that portion of the three-week period following surgery during which the device is used in the patient’s home.

For example:

  • Date of surgery = 06/01/2009
  • Date that CPM device was applied = 06/02/2009
  • Date of discharge from hospital/home use begins = 06/05/2009
  • End of coverage = 06/22/2009
  • Beneficiary use of device ends = 06/29/2009

Bill from 06/05/2009 to 06/29/2009. E0935RR, 25 days, (25 UOS). Medicare will cover 18 days (06/05–06/22). The additional days will be denied as not medically necessary. 

When billing for a CPM device, please remember the following:

  • The “From” date should represent the date the CPM device began use in the beneficiary’s home
  • Suppliers should bill the date the use of the device ends as the “To” date
  • Coverage for the CPM device is limited to that portion of the 21-day period following surgery during which the device is used in the patient’s home. Additional days over the 21-day period will be denied as not medically necessary
  • The UOS should reflect the actual number of calendar days the CPM was used by the beneficiary in the home
  • The ICD-9 code V43.65 represents a total knee replacement

When billing for a CPM device the claim must include all the following information:

  • State the type of surgery performed (such as “total knee replacement”) or provide the CPT code for the surgical procedure (e.g., 27447, 27486, or 27487)
  • Date of the surgery
  • Date the device was initiated
  • Date of discharge from the hospital or NH (if the patient is discharged from the hospital to a SNF or rehabilitation center before going home, please use the discharge date when the patient went home)

Suppliers billing electronically should include this information in the NTE record. The following is an example of condensing the required information since there are now fewer characters allowed in the NTE record:

“SURGERY DT 6/1/09 DT APPLIED 6/2/09 DT D/C HOME 6/5/09 CPT 27447”

Claims submitted without required information will be denied as not medically necessary. Suppliers should always bill dates of service on one claim. Billing one or two dates of service on several claims will cause a delay in processing and payment. You can find the latest information on CPM devices on the CMS Web site.

Continuous Passive Motion Devices
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