Mechanical stretching devices (also described as dynamic splinting systems) are designed to provide controlled, prolonged low-load stretches to prevent or treat joint contractures that can arise from immobilization, surgery, disease, or trauma. Device types addressed in this policy include low-load prolonged-duration stretch (LLPS) devices (dynamic splints intended to provide prolonged passive stretching often during rest or sleep), static progressive stretch (SPS) splints (which hold a joint at a set position with manual angle modification and do not allow active motion), and patient-actuated serial stretch (PASS) devices (patient-controlled pneumatic or mechanical loading systems) (see device descriptions and intended use).
These mechanical stretching devices are used with the goal of maintaining or restoring joint range of motion (ROM) and may replace some therapist-directed sessions by providing frequent, consistent joint mobilization in the home or hospital setting. LLPS/dynamic splinting systems are available for multiple joints, including finger, wrist, elbow, knee, ankle, toes, and shoulder; prefabricated and custom units exist depending on limb size, required load, and treatment needs.
The evidence base differs by device type. The policy recognizes LLPS (dynamic splinting) devices as supported by clinical evidence and medically necessary when used as an adjunct to a physical therapy program for treatment of existing joint contractures of the upper and lower extremities, particularly for certain joints (finger, wrist, elbow, knee, toe) where randomized trials, observational studies, and systematic reviews show benefit in improving ROM when appropriately applied. In contrast, the available peer-reviewed evidence is insufficient or mixed for SPS and PASS devices; clinical studies and reviews do not reliably demonstrate consistent efficacy for static progressive or patient-actuated serial stretch devices, and the policy considers SPS and PASS unproven and not medically necessary when used alone or combined with standard physical therapy for treating joint contractures.
Providers should note the list of applicable HCPCS codes for these devices and that the policy was updated with quarterly coding changes (for example, addition of E1832 and revisions to descriptions for codes such as E1801, E1811, E1816, E1818, and E1841). Also note this Medical Policy does not apply to certain states; refer to state-specific policy versions where indicated (see Application).