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E1800 |
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Dynamic adjustable elbow extension/flexion device, includes soft interface material
| short | Adjust elbow ext/flex device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1801 |
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Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories
| short | Sps elbow device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1802 |
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Dynamic adjustable forearm pronation/supination device, includes soft interface material
| short | Adjst forearm pro/sup device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1805 |
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Dynamic adjustable wrist extension / flexion device, includes soft interface material
| short | Adjust wrist ext/flex device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1806 |
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Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories
| short | Sps wrist device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1810 |
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Dynamic adjustable knee extension / flexion device, includes soft interface material
| short | Adjust knee ext/flex device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1811 |
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Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories
| short | Sps knee device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1812 |
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Dynamic knee, extension/flexion device with active resistance control
| short | Knee ext/flex w act res ctrl |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1815 |
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Dynamic adjustable ankle extension/flexion device, includes soft interface material
| short | Adjust ankle ext/flex device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1816 |
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Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories
| short | Sps ankle device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1818 |
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Static progressive stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories
| short | Sps forearm device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1820 |
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Replacement soft interface material, dynamic adjustable extension/flexion device
| short | Soft interface material |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
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E1821 |
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Replacement soft interface material/cuffs for bi-directional static progressive stretch device
| short | Replacement interface spsd |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
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E1825 |
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Dynamic adjustable finger extension/flexion device, includes soft interface material
| short | Adjust finger ext/flex devc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
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E1830 |
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Dynamic adjustable toe extension/flexion device, includes soft interface material
| short | Adjust toe ext/flex device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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E1831 |
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Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories
| short | Static str toe dev ext/flex |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1840 |
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Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material
| short | Adj shoulder ext/flex device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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E1841 |
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Static progressive stretch shoulder device, with or without range of motion adjustment, includes all components and accessories
| short | Static str shldr dev rom adj |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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