Rehabilitative Devices with Remote Monitoring
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Defines coverage stance for rehabilitative devices that monitor or remotely adjust therapy (e.g., ROM devices, diabetic foot ulcer boots) for Medicare Advantage and commercial products under BCBSRI.
No material clinical or coverage changes in this revision.
Coverage Determination
Overall coverage determination
Examples cited in the source include ROMTech PortableConnect®, ROMTech AccuAngle®, and the Sensoria diabetic foot ulcer boot.
For Medicare Advantage plans, the use of rehabilitative devices that include remote monitoring or remote adjustment capabilities is not covered for all indications because the evidence is insufficient to show an improvement in net health outcome.
For Commercial products, rehabilitative devices with remote monitoring or remote adjustment capabilities are considered not medically necessary for all indications due to insufficient evidence demonstrating incremental health outcome benefit compared with widely accepted alternative therapies.
Billing Codes
| E1399 | Durable medical equipment, miscellaneous |
Provider Responsibilities & Billing
Prior authorization
Not applicable
Benefits variability
Benefits may vary by group or contract. Refer to the member's Evidence of Coverage or Subscriber Agreement for applicable benefit restrictions and to determine whether the service is covered, excluded, or considered not medically necessary under the member's plan.
Billing and benefits verification
File using HCPCS code E1399 (Durable medical equipment, miscellaneous). Verify member benefits and any applicable coverage restrictions with the Evidence of Coverage or Subscriber Agreement prior to billing.
- HCPCS: E1399 - Durable medical equipment, miscellaneous
Coverage denial risk
Coverage for rehabilitative devices with remote monitoring or adjustment capabilities: not covered for Medicare Advantage plans (evidence insufficient to show improved net health outcome) and considered not medically necessary for Commercial products.
Background
Rehabilitative devices with remote monitoring or adjustment capabilities are intended to evaluate and support improvements in range of motion (ROM) and muscle strength by delivering therapy sessions and reporting session-level data (for example, compliance, duration, and activity logs) to the treating clinician in near–real time. Examples include wearable ROM devices and diabetic foot ulcer boots that send status updates and removal times to clinicians. Published studies are limited, and no national guidelines currently endorse these devices; available evidence has not demonstrated an incremental clinical benefit over standard rehabilitation approaches.
Key Definitions
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