The CPM devices (HCPCS code E0935) are classified as items requiring frequent and
substantial servicing and are covered as DME as follows (see the Medicare National
Coverage Determinations Manual.):
• Continuous passive motion devices are covered for patients who have received a
total knee replacement. To qualify for coverage, use of the device must
commence within 2 days following surgery. In addition, coverage is limited to
that portion of the 3 week period following surgery during which the device is
used in the patient's home.
MACs make payment for each day that the device is used in the patient's home. No
payment can be made for the device when the device is not used in the patient's home or
once the 21 day period has elapsed. Since it is possible for a patient to receive CPM
services in their home on the date that they are discharged from the hospital, this date
counts as the first day of the three week limited coverage period.
30.3 - Certain Customized Items
(Rev. 2687, Issued: 04-19-13, Effective: 01-01-92, Implementation: 07-19-13)
Customized items are rarely necessary and are rarely furnished. In accordance with 42
CFR Section 414.224, in order to be considered a customized item, a covered item
(including a wheelchair) must be uniquely constructed or substantially modified for a
specific beneficiary according to the description and orders of a physician and be so
different from another item used for the same purpose that the two items cannot be
grouped together for pricing purposes. For example, a wheelchair that is custom
fabricated or substantially modified so that it can meet the needs of wheelchair-confined,
conjoined twins facing each other is unique and cannot be grouped with any other
wheelchair used for the same purpose. It is a one-of-a-kind item fabricated to meet
specific needs. Items that are measured, assembled, fitted, or adapted in consideration of
a patient’s body size, weight, disability, period of need, or intended use (i.e., custom
fitted items) or have been assembled by a supplier or ordered from a manufacturer who
makes available customized features, modification or components for wheelchairs that
are intended for an individual patient’s use in accordance with instructions from the
patient’s physician do not meet the definition of customized items. These items are not
uniquely constructed or substantially modified and can be grouped with other items for
pricing purposes. The use of customized options or accessories or custom fitting of
certain parts does not result in a wheelchair or other equipment being considered as
customized. The item must be uniquely constructed using raw materials or there must be
a necessary, substantial modification to the base equipment (e.g., wheelchair frame) for
the item to be considered a customized item.
Section 414.224 (b) provides that payment is made for the lump sum purchase of the item
based on the MAC’s individual consideration and judgment of a reasonable payment
amount for each customized item. The MAC’s individual consideration takes into
account written documentation on the costs (including design, fabrication, and assembly
costs) of the item including at least the cost of labor, to the extent that they are