Does E0935 require prior authorization?

Yes, E0935 requires prior authorization (high confidence). Code explicitly requires prior authorization.

`E0935`, Continuous passive motion exercise device for use on knee only

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Documentation of prior conservative/standard therapy attempts where relevant (for indications where evidence is limited and clinical rationale is required).
Where the CPM device is used for surgical rehabilitation, documentation must demonstrate that use commenced within 2 days following surgery to meet medical necessity guidelines. (Policy text: "Where the CPM device is used for surgical rehabilitation, the use of this device must commence within 2 days following surgery to meet medical necessity guidelines.")
Documentation must support that CPM is being used only until the member is participating in an active PT program or until the member begins the weight-bearing phase of recovery, as applicable. (Policy text: "Once the patient is participating in active PT, CPM is no longer medically necessary." and "Once the patient is weight-bearing, CPM is no longer necessary.")

ICD-10 codes covered if selection criteria are met: G90.50 - G90.59 (Complex regional pain syndrome I (CRPS I)).
ICD-10 codes covered if selection criteria are met: M23.200 - M23.369; M24.80 - M24.9 (Internal derangement of knee and other joints).
ICD-10 codes covered if selection criteria are met: M72.0 (Palmar fascial fibromatosis [Dupuytren]).
ICD-10 codes covered if selection criteria are met: M75.00 - M77.9 (Peripheral and other enthesopathies).
ICD-10 codes covered if selection criteria are met: Numerous options — Musculoskeletal and connective tissue injuries, sequela.
ICD-10 codes covered if selection criteria are met: M93.20 - M93.29 (Osteochondritis dissecans).

ANTHEM-CG-DME-52, Continuous Passive Motion Devices in the Home Setting

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

AETNA-CPB-0010, Continuous Passive Motion (CPM) Machines

BCBSIL-DME101.023, Continuous Passive Motion in the Home Setting

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