CurrentCignaPolicy 0198

Continuous Passive Motion (CPM) Devices

This Cigna medical coverage policy governs use of continuous passive motion (CPM) devices for rehabilitation after surgery and other conditions for members of Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyContinuous Passive Motion (CPM) Devices

Policy CodePolicy 0198

Change TypeAnnual review — no clinical changes

Effective DateAug 15, 2025

Next Review DateAug 15, 2026

Key ActionDo not submit claims for CPM devices billed with E0935 or E0936 as they are considered not medically necessary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

8/15/2025effective date

Not coveredcoverage stance

E0935, E0936not medically necessary HCPCS

StrongAAOS guidance

Class IFDA class

Coverage determination and criteria

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inv-01: Overall coverage determination

Covered when ALL of the following are met:

General coverage stance: The use of a continuous passive motion (CPM) device is considered not medically necessary for ANY indication.

Policy statement applies universally to CPM use

inv-02: Overall coverage rationale

Rationale for coverage determination — key evidence and guideline findings informing the stance:

General stance: Insufficient evidence supports CPM effectiveness after upper extremity surgery; AHRQ excluded CPM from joint replacement reviews due to evidence of ineffectiveness; professional society guidance (AAOS, APTA) finds that CPM does not improve outcomes after knee arthroplasty and recommends against routine use after primary uncomplicated total knee arthroplasty.

References: literature review and professional guidelines

The use of a continuous passive motion (CPM) device is excluded from medical necessity coverage for any indication. Reimbursement is not allowed for services billed for conditions or diagnoses that would require CPM because this policy considers CPM not medically necessary for any use.

Use of continuous passive motion devices billed with HCPCS codes E0935 and E0936 is considered not medically necessary under this policy. E0935 is described as a continuous passive motion exercise device for use on the knee only; E0936 is described as a continuous passive motion exercise device for use other than the knee.

The policy statement is clear: use of continuous passive motion (CPM) devices is not medically necessary for any indication. Providers should expect requests for CPM devices or related services to be denied when submitted for coverage under Cigna-administered health benefit plans.

HCPCS codes E0935 (continuous passive motion exercise device for knee only) and E0936 (continuous passive motion exercise device for use other than knee) are explicitly listed as considered not medically necessary in this policy.

Provider actions, prior authorization, and denial risk

Prior Authorization

Prior authorization and CPM coverage

Coverage determinations depend on the applicable benefit plan. Submit requests per the member's plan criteria and benefit document; medical directors retain discretion to make individual coverage determinations.

Submit services in accordance with the relevant Coverage Policy and use the most appropriate codes as of the date of submission.
Coverage is ultimately determined by the terms of the applicable benefit plan document.

Denial Risk

CPM device prior authorization stance / Denial triggers

Requests for reimbursement for CPM devices billed with HCPCS E0935 or E0936 will be denied as not covered because CPM is considered not medically necessary for any indication.

HCPCS E0935 — Continuous passive motion exercise device for use on knee only.
HCPCS E0936 — Continuous passive motion exercise device for use other than knee.

Prior Authorization

Prior authorization unchanged

Annual reviews on 2024-08-15 and 2025-08-15 noted no clinical policy statement changes and did not add or change prior authorization requirements.

No new authorization triggers were added during annual reviews.

Billing Rule

Billing and coding expectation

Providers must bill in accordance with the relevant Coverage Policy and use the most appropriate, current codes. Deleted or inactive codes at the time of service may not be eligible for reimbursement.

Review current CPT/HCPCS coding and any applicable NCD/LCD determinations before submission.
Ensure submitted codes correspond to covered services under the member's benefit plan.

Documentation Required

Coding and documentation note

Ensure coding is current and review Medicare NCD/LCD determinations and policy updates; deleted or inactive codes may not be eligible for reimbursement.

Check National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) where applicable.
Do not rely on deleted or inactive codes when submitting claims.

Step Therapy

Step therapy / utilization preference

CPM is described as generally used as an adjunct to active physical therapy; guidelines recommend against routine CPM after uncomplicated primary TKA — active PT is preferred prior to considering CPM.

CPM should not be routine after uncomplicated primary total knee arthroplasty; prioritize active physical therapy.
Step therapy or utilization preference: active PT is the preferred initial rehabilitation approach prior to considering adjunctive modalities.

Definitions and device classification

inv-22: Continuous passive motion (CPM) — definition: progressive passive range of motion without active muscle contraction

DefinitionProvides progressive passive range of motion to an extremity through an externally applied force without active muscle contraction.

Device componentsConsists of a carriage to support the extremity and a programmable controller for ROM, speed, pause, and duration of treatment.

MechanismJoint is secured in the device and the device flexes and extends the joint passively (no patient muscle activation).

Therapeutic rationaleIntended to decrease soft tissue stiffness, increase ROM, promote healing of joint surfaces and prevent adhesions.

Typical useCommonly used as an adjunct to active physical therapy in the postoperative rehabilitation period, most often after knee surgery (e.g., TKA).

inv-23: FDA classification — CPM machines are Class I devices generally exempt from 510(k)

FDA device classClass I medical device.

Premarket notification statusGenerally exempt from FDA 510(k) premarket notification.

Common joint availabilityAvailable for multiple joints (knee most common; also elbow, hip, ankle, shoulder, fingers).

Examples of productsExamples cited include Artromot, Danniflex, Elbow CPM Orthosis, Jace CPM, Mobilimb/Multilink, and Sutter CPM devices.

inv-24: CPM (continuous passive motion) — device definition used postoperatively

Device descriptionA device that passively moves a joint through a predetermined range of motion without patient muscle activation.

Clinical contextUsed postoperatively for rehabilitation of synovial joints and associated tissues, commonly after knee surgery.

Role in careGenerally used as an adjunct to active physical therapy during the rehabilitation period following surgery or injury.

inv-25: Continuous passive motion (CPM) — alternate definition / description referenced in document

Alternate descriptionA rehabilitation technique delivering programmed passive ROM to a joint to decrease stiffness, increase ROM, promote healing, and prevent adhesions.

Therapy deliveryDuring therapy the joint is secured in the device and passively flexed and extended per a programmed regimen (speed, duration, pause).

Adjunctive useProposed to enhance recovery by improving blood flow and reducing pain; most literature evaluates CPM after total knee arthroplasty and other joint surgeries.

Evidence contextCPM is discussed across multiple randomized trials and systematic reviews cited in the references supporting the therapy description and outcomes research.

OpenPayer

Continuous Passive Motion (CPM) Devices

Coverage determination and criteria

Coding and billing codes

Provider actions, prior authorization, and denial risk

Clinical background and context

Definitions and device classification

E0935	Continuous passive motion exercise device for use on knee only.
E0936	Continuous passive motion exercise device for use other than knee.