Mechanical stretching devices (dynamic splinting systems) are used to prevent and treat joint contractures by providing controlled joint mobilization to maintain or restore joint range of motion. The policy groups devices into three categories: LLPS (low-load prolonged-duration stretch or dynamic splinting systems used often during rest/sleep), SPS (static progressive splints that hold a joint at a set position with manual angle adjustment and do not exert continuous motion stress), and PASS (patient-actuated serial stretch devices that use pneumatic or hydraulic loading adjusted by the patient). The evidence summary states that LLPS devices have demonstrated effectiveness for certain joints (finger, wrist, elbow, knee, toes) in some trials and reviews, whereas SPS and PASS lack sufficient evidence in the published literature to demonstrate safety and efficacy for treating joint contractures.

When making coverage decisions, the member-specific benefit plan governs and medical records documentation may be required to assess whether clinical criteria are met. In the absence of a Medicare NCD/LCD, Medicare Advantage Organizations (MAOs) may create their own coverage determinations using objective evidence-based rationale; the brief does not list a Medicare effective date or number for a Medicare NCD (fields empty) and advises that rationale should be documented when applying this policy to MA members.