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Medical Policy Revision: Continuous Passive Motion Device

Effective March 14, 2019, we will change the way we process certain claims based on revisions to our medical policy, Continuous Passive Motion Device.

Access our Medical Policy Manual to review this medical policy content.¹


Claims submitted for services provided on and after March 14, 2019 and after will be processed as noted below.

  • HCPCS code E0935 included on claims for services provided to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans may be denied, based on the submitted diagnosis code(s) as not medically necessary.
  • HCPCS codes E0935 and/or EO936 included on claims for services provided to patients enrolled in Horizon BCBSNJ commercial and Administrative Services Only (ASO) plans may be denied if the procedure code is not related to the submitted diagnosis code(s).

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for services on and after March 14, 2019.

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

Published on: December 12, 2018, 13:30 p.m. ET
Last updated on: December 12, 2018, 13:31 p.m. ET