CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Constraint-induced movement therapy (CIMT)

This medical policy defines Blue Cross Blue Shield - Rhode Island's coverage position for constraint-induced movement therapy (CIMT) for all indications and provides coding guidance and background. It applies to commercial and Medicare Advantage products where BCBSRI policy governs medical necessity determinations.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyConstraint-induced movement therapy (CIMT)

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionRefer to the member's Benefit Booklet, Evidence of Coverage or Subscriber Agreement for benefit-specific determinations; note that claims for CIMT may be denied as not medically necessary per this policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes — policy remains that CIMT is not covered due to insufficient evidence.

1Coverage stance

1Unlisted CPT provided

8Provider updates listed (2014-2021)

Coverage Summary

Background: Constraint-induced movement therapy (CIMT) (forced use therapy) is an intensive physical therapy approach developed to overcome learned nonuse after central nervous system injury. It aims to reorganize and reprogram the brain and typically includes constraining the less-impaired upper extremity, intensive repetitive therapist-directed practice of the impaired extremity over an extended period (2-3 weeks), and shaping through rewarding successive approximations.

Scope summary: This medical policy defines Blue Cross Blue Shield - Rhode Island's coverage position for constraint-induced movement therapy (CIMT) for all indications and provides coding guidance and background. It applies to commercial and Medicare Advantage products where BCBSRI policy governs medical necessity determinations.

Medical Necessity / Coverage Determination

Policy Statement / Coverage Determination

Constraint-induced movement therapy is not covered when ANY of the following apply:

Constraint-induced movement therapy (CIMT) is not covered for any indication because there is insufficient peer-reviewed scientific literature that demonstrates that the service is effective.

Background (informational)

CIMT is an intensive therapy developed to overcome learned nonuse; protocols vary and existing studies are inconsistent, so high-quality research is required to support its use.

Coding Guidance

There are no specific codes for this service; to report use unlisted physical medicine code CPT 97799.

Filing Instruction

Do not file this service with other Physical Medicine and Rehabilitation codes.

Benefit Verification

Benefits may vary between groups/contracts; refer to the member's Benefit Booklet, Evidence of Coverage or Subscriber Agreement for benefit-specific determinations.

Provider Notice

Claims for CIMT may be denied as not medically necessary for any indication per this policy because evidence is insufficient to demonstrate effectiveness.

Commercial Products Specific Statement

Commercial Products Specific Statement: For Commercial Products, CIMT is considered not medically necessary for any indication due to insufficient peer-reviewed scientific literature demonstrating effectiveness.

Not Covered / Rationale

Rationale for non-coverage: CIMT protocols vary widely in constraint type, intensity, duration, and outcome measures, and the published literature consists of numerous case series and a small number of randomized or controlled clinical trials with inconsistent methods and outcomes. Multiple systematic reviews and RCTs have been cited but are considered inconsistent and insufficient to establish effectiveness.

BCBSRI requires higher-quality research to demonstrate which techniques, if any, are clinically useful; because methods and outcomes are inconsistent among clinical trials, CIMT is considered not medically necessary for any indication until sufficient peer-reviewed scientific literature establishes effectiveness.

Not Covered Conditions (Operational Clarification)

Not covered when ANY of the following apply:

Not Covered Conditions (operational)

Constraint-induced movement therapy (CIMT) is not covered for any indication because there is insufficient peer-reviewed scientific literature that demonstrates that the service is effective.

Provider Actions / Billing Impact

Billing Rule

Use unlisted CPT when reporting

There are no specific codes for CIMT; to report this service use the unlisted physical medicine code CPT 97799.

97799

Documentation Required

Benefit verification required

Benefits may vary between groups/contracts. Providers must refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for benefit-specific determinations.

Denial Risk

Service is not medically necessary

Constraint-induced movement therapy is considered not medically necessary for any indication due to insufficient peer-reviewed scientific literature demonstrating effectiveness. Claims for CIMT may be denied as not medically necessary for any indication per this policy.

Claims may be denied for any indication per this policy because evidence is insufficient to demonstrate effectiveness.

Background & Definitions

Constraint-induced movement therapy (CIMT), also known as forced use movement therapy, is a form of intensive physical therapy aimed at reorganizing and reprogramming the brain after a stroke, traumatic brain injury, spinal cord damage, or neuromotor disorder. CIMT developed out of behavioral research on the phenomenon of learned nonuse of an upper extremity observed following sensory and/or motor central nervous system injury, in which failure to use persists even after partial recovery. CIMT includes three elements: (1) constraining the use of the less-impaired upper extremity; (2) intensive, repetitive daily therapist-directed practice of motor movements with the impaired upper extremity for an extended period (2-3 weeks); and (3) shaping of more complex action patterns through rewarding successive approximations to the target action. Numerous case studies and a small number of randomized or controlled clinical trials have reported functional gains, but protocols vary widely in type of constraint used, intensity and duration of training, and outcome measures. High-quality research is required because methods and outcomes are inconsistent among clinical trials and it has not been proven which techniques, if any, are clinically useful; further studies are needed to determine optimal treatment protocols.

Constraint-induced movement therapy (CIMT): An intensive physical therapy involving constraining the less-impaired upper extremity, intensive repetitive therapist-directed practice of the impaired extremity over an extended period (2-3 weeks), and shaping through rewarding successive approximations.

Evidence summary: Multiple systematic reviews and randomized controlled trials (including Cochrane reviews and other systematic reviews cited) have examined CIMT, but findings are inconsistent and considered insufficient to establish clinical effectiveness. A number of references and trials (EXCITE trial, various systematic reviews and meta-analyses, and pediatric studies) are listed, yet the policy concludes that higher-quality, consistent research is required to determine which techniques and protocols, if any, are clinically useful.