CurrentCignaPolicy N/A

Therapy Services — Range of Motion (ROM) Testing Coverage Criteria

Defines clinical coverage and documentation requirements for CPT 95851-95852 ROM testing when performed to evaluate patients with multi-extremity or trunk impairment and when testing is beyond standard E/M or therapy evaluation services. Applies to providers submitting claims to Cigna.

Policy Summary

PayerCigna

PolicyTherapy Services — Range of Motion (ROM) Testing Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 15, 2025

Next Review DateJun 15, 20261d

Key ActionDocument a separate, dated and signed written interpretation report describing purpose, tests performed with results, and impact on the treatment plan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2CPT codes designated in policy (95851-95852)

Examples listedClinical examples listed

RequiredReport required

Coverage Criteria for ROM Testing

Medically Necessary Criteria for ROM Testing

Covered when ALL of the following are met:

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Clinical indications and purpose: Testing is for medical conditions that impact multiple extremities and trunk musculature and when further testing beyond E/M or standard therapy evaluation/re-evaluation is required to develop a plan of care (examples: spinal cord injury, traumatic brain injury, neurologic conditions such as multiple sclerosis or stroke, movement disorders such as Parkinson's disease or cerebral palsy).

Pertinence and documentation: Testing must be pertinent to the plan of care and the diagnosis, and generate a written interpretation report that is dated and signed describing purpose/rationale, tests performed with results, and impact on treatment plan.

Completeness per code descriptor: Every muscle or joint in the affected extremity or trunk section described in the code descriptor must be tested when coding these procedures (e.g., 95851 requires testing of every joint of an extremity), with documentation justifying the comprehensiveness.

Not routine: ROM testing codes are not reasonable or necessary for routine or periodic use (e.g., monthly) or as a substitute for standard reevaluation/E/M codes; baseline measurements during initial evaluations are incidental and included in E/M or therapy evaluation/re-evaluation services.

Baseline range of motion (ROM) measurements performed as part of an initial Evaluation and Management (E/M) service or as part of a therapy evaluation/reevaluation are considered incidental and are included in those services. The policy specifies that typical E/M (and therapy/occupational therapy evaluation and reevaluation) codes already include the necessary objective measurements, including ROM; therefore separate billing of ROM codes for baseline measurements taken during an initial evaluation is not appropriate. Do not bill CPT 95851 or 95852 for baseline ROM taken during the initial E/M or therapy evaluation/reevaluation.

When a ROM code descriptor requires testing of an entire extremity or trunk section, every muscle or joint in that specified extremity or trunk section must be tested and documented. For example, CPT 95851 is defined as “range of motion measurements and report; each extremity (excluding hand) or trunk section (spine),” so it is not appropriate to report 95851 for testing of a single joint (e.g., only the shoulder). Documentation must justify why a comprehensive assessment was warranted. Use of ROM codes for partial or limited joint testing when the code descriptor requires complete testing is not acceptable.

Provider Actions, Documentation & Billing

Note

Prior Authorization

No explicit prior authorization requirement is stated in this policy.

Step Therapy

No step therapy requirements are indicated for ROM testing — there are no prerequisite treatments or prior trial requirements specified before performing ROM testing codes (CPT 95851-95852).

Documentation Required

Report and Documentation Requirements

The practitioner must provide an interpretation and a separate, distinct, dated, and signed written report when billing CPT codes 95851-95852. The report should state the purpose and rationale for the test, describe the test performed with results, and explain how the findings affect the treatment plan. ROM testing is typically consultative; documentation must support why testing beyond routine E/M, evaluation, or reevaluation was necessary (for example, specialized testing for complex conditions).

Applicable codes: CPT 95851, 95852
Report must be separate, distinct, dated and signed
Include purpose/rationale, methods, results, impact on plan

Documentation Required

Scope of Testing Documentation

Every muscle or joint in the affected extremity or trunk section described by the code descriptor must be tested and documented when using CPT codes 95851/95852. Documentation should justify why a comprehensive assessment was warranted (for example, testing the entire extremity when billing 95851 rather than a single joint). Routine or repetitive use of these codes (e.g., monthly or instead of a standard reevaluation/E/M) is not considered reasonable or necessary. Use of digital devices alone that produce reports does not by itself justify use of these codes.

When coding 95851, every joint of the extremity must be tested and documented
Testing must be relevant to the plan of care and diagnosis
Digital device reports do not automatically justify code use

Denial Risk

Denial Risk for Non‑covered or Insufficiently Documented Services

Claims submitted for services that are not accompanied by covered code(s) under this policy will be denied as not covered. Ensure submitted codes, documentation and reports meet the policy criteria and the member’s benefit plan terms.

Verify covered CPT codes (e.g., 95851-95852) and appropriate documentation prior to claim submission
Denials may result if tests are routine, not supported by documentation, or billed with inappropriate codes

Background

Range of motion testing quantifies joint and muscle movement and can be necessary beyond the routine measurements performed during standard E/M or therapy evaluations for patients with complex or multi-region impairments (for example, certain neurologic injuries or disorders). The policy notes that CPT 95851-95852 are designated as separate procedures that require the practitioner’s interpretation and a separate, distinct, dated and signed written report. Testing should be relevant to the plan of care and diagnosis, reserved for cases where additional, specialized ROM measurement will influence treatment decisions, and should not be performed routinely or as a substitute for standard reevaluation/E/M services.

Code Definitions

inv-11: CPT 95851 — Range of motion measurements and report; each extremity (excluding hand) or each trunk section (spine).

CodeCPT 95851

DefinitionRange of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine).

Documentation requirementPractitioner interpretation with a separate, distinct, dated and signed written report is required; report should state purpose/rationale, tests performed with results, and impact on treatment plan.

Scope of testingEvery muscle or joint in the affected extremity or trunk section described in the code descriptor must be tested and documentation must justify why a thorough assessment was warranted (e.g., 95851 requires testing of every joint of an extremity).

inv-12: CPT 95852 — Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side.

CodeCPT 95852

DefinitionRange of motion measurements and report (separate procedure); hand, with or without comparison with normal side.

Separate procedure noteDesignated as a separate procedure and requires the practitioner's interpretation of the results along with a separate, distinct, dated and signed written report.

Use contextTypically reserved for testing beyond routine E/M or therapy evaluations when specialized testing and standardized reports are warranted (e.g., complex neurologic or multi-extremity conditions).

OpenPayer

Therapy Services — Range of Motion (ROM) Testing Coverage Criteria

Coverage Criteria for ROM Testing

Codes and Coding Guidance

Provider Actions, Documentation & Billing

Background

Code Definitions

95851	Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine).
95852	Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side.