Medical Policy Update: Continuous Passive Motion (CPM) in the Home Setting

Effective November 27, 2017, the guidelines of our medical policy, Continuous Passive Motion (CPM) in the Home Setting, will be applied to claims for services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans.

The guidelines of this policy identify when the use of a CPM device in a home setting is considered medically necessary or investigational.

We encourage you to review this revised policy in our Medical Policy Manual.

Based on the guidelines of our medical policy, Continuous Passive Motion (CPM) in the Home Setting, AND the submitted diagnosis code(s), HCPCS codes E0935 and/or EO936 included on claims for services provided on and after November 27, 2017 to members enrolled in Horizon BCBSNJ MA plans may be denied as not medically necessary services.

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 on and after November 27, 2017.