DraftBlue Cross Blue Shield - Rhode IslandPolicy N/A

Continuous Passive Motion Devices with Remote Monitoring or Adaptive Capabilities

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This policy governs coverage of continuous passive motion devices or systems with remote monitoring or adaptive capabilities for Blue Cross Blue Shield of Rhode Island Medicare Advantage and commercial products. The technology is investigational and not covered for Medicare Advantage or not medically necessary for commercial products because evidence is insufficient to determine its effects on health outcomes.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyContinuous Passive Motion Devices with Remote Monitoring or Adaptive Capabilities

Policy CodePolicy N/A

Change TypeNo material change

Effective DateDec 1, 202622d

Last ReviewAug 19, 2026

Next Review DateN/A

Key ActionCoverage is subject to the member's applicable benefit booklet, Evidence of Coverage, subscriber agreement, or other governing contract.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredMedicare Advantage coverage stance

Not medically necessary

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DraftBlue Cross Blue Shield - Rhode IslandPolicy N/A

Continuous Passive Motion Devices with Remote Monitoring or Adaptive Capabilities

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Sign up for all Blue Cross Blue Shield - Rhode Island policy alerts

Know when Blue Cross Blue Shield - Rhode Island releases new policies or updates existing guidance.

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Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyContinuous Passive Motion Devices with Remote Monitoring or Adaptive Capabilities

Policy CodePolicy N/A

Change TypeNo material change

Effective DateDec 1, 202622d

Last ReviewAug 19, 2026

Next Review DateN/A

Key ActionCoverage is subject to the member's applicable benefit booklet, Evidence of Coverage, subscriber agreement, or other governing contract.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredMedicare Advantage coverage stance

Not medically necessary

Coverage Criteria

Medicare Advantage: Investigational and not covered

For Medicare Advantage Plans:

Investigational continuous passive motion technology: Devices or systems featuring continuous passive motion with remote monitoring or adaptive capabilities are considered investigational and are not covered.

Evidence is insufficient to determine the effects of the technology on health outcomes.

Commercial: Investigational and not medically necessary

For Commercial Products:

Evidence is insufficient to determine the effects of the technology on health outcomes.

For Medicare Advantage Plans, devices or systems featuring continuous passive motion with remote monitoring or adaptive capabilities are considered investigational and not covered. Evidence is insufficient to determine the effects of the technology on health outcomes.

For Commercial Products, devices or systems featuring continuous passive motion with remote monitoring or adaptive capabilities are considered investigational and not medically necessary. Evidence is insufficient to determine the effects of the technology on health outcomes.

Coding Information

Medicare Advantage Plans and Commercial ProductsHCPCS

E1399

Durable medical equipment, miscellaneous

Provider Actions

Denial Risk

Medicare Advantage: Investigational Technology

For Medicare Advantage Plans, devices or systems featuring continuous passive motion with remote monitoring or adaptive capabilities are considered investigational and are not covered because evidence is insufficient to determine their effects on health outcomes. Claims for this technology may be denied as not covered.

Denial Risk

Commercial: Investigational Technology

For Commercial Products, devices or systems featuring continuous passive motion with remote monitoring or adaptive capabilities are considered investigational and not medically necessary because evidence is insufficient to determine their effects on health outcomes. Claims for this technology may be denied as not medically necessary.

Note

Verify Member-Specific Benefits

Coverage is governed by the member's applicable benefit documents and contract. Benefits may vary by group and contract; refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable not medically necessary and not covered benefits or coverage.

Background

Continuous passive motion devices provide passive movement and may incorporate telehealth conferencing, remote monitoring, remote adjustment, or adaptive pedal functions that support active and resistance modes. These devices are generally FDA class I devices exempt from 510(k) requirements. Clinical evidence for remote-monitoring rehabilitation systems is limited in quality; a retrospective 2023 study reported improved outcomes after total knee arthroplasty, but its generalizability was limited by retrospective design, non-blinded assessment, lack of protocol standardization, and greater treatment and communication intensity in the home-based group.

Not Covered

Devices or systems featuring continuous passive motion with remote monitoring or adaptive capabilities are not covered under Medicare Advantage Plans because the technology is considered investigational and evidence is insufficient to determine its effects on health outcomes.