Appeal type: Experimental/Investigational
Decision: Overturned Decision of Health Plan

Physician 1: The patient is a 57-year-old man who underwent an osteotomy for deformity. Postoperatively, a continuous passive motion (CPM) machine was ordered to help regain/maintain knee motion. The patient utilized the CPM machine with good results.Use of a CPM machine was appropriate in the case of this patient. Given the patients age and type of surgery required, and given the close proximity to the knee joint, the CPM machine helped to maintain motion at a time when the patients pain level was such that he would not have been able to move his knee. The CPM machine has indications other than total joint replacement and this case is an example of appropriate use of the device. Therefore, I have determined that the equipment at issue was likely to be more beneficial for treatment of the patients medical condition than any available standard therapy. The Health Plans denial should be overturned.Physician 2: The patient is a 57-year-old male who is status post closing wedge varus osteotomy with bone graft and plate fixation of the left distal femur. Following surgery, the patient utilized a continuous passive motion (CPM) machine as recommended by his provider. The patient has requested reimbursement for the CPM machine. The Health Plan has denied the patients request.Loss of range of motion following osteotomies around the knee (either proximal tibial osteotomy or distal femoral osteotomy) is a well-known and well-documented complication. Because active range of motion exercises following such procedures are either painful or not allowed to be performed (in cases of sub-optimal fixation), the only alternative is use of CPM. The use of a CPM machine in this case was not only reasonable, but medically indicated to optimize range of motion, facilitate earlier discharge from the hospital, and to potentially lessen the need for extended formal physical therapy as an outpatient. Therefore, I have determined that the equipment at issue was likely to be more beneficial for treatment of the patients medical condition than any available standard therapy. The Health Plans denial should be overturned.Physician 3: The patient is a 57-year-old male who is status post femur varus osteotomy surgery for correction of post-traumatic deformity. The patient used a continuous passive motion (CPM) machine for several weeks following surgery. The patient has requested reimbursement for use of the CPM machine. The Health Plan has denied the patients request citing a lack of evidence CPM therapy is efficacious for patients such as this patient.There is insufficient medical literature to support the use of postoperative CPM machines in cases of post-traumatic limb deformity surgery. The literature does not support CPM as being more effective than physical therapy alone in cases other than total knee replacement surgery. Due to the paucity of literature, there is inadequate evidence demonstrating the efficacy of the CPM machine. Therefore, I have determined that the equipment at issue was not likely to be more beneficial for treatment of the patients medical condition than any available standard therapy. The Health Plans denial should be upheld.