Continuous Passive Motion (CPM) Devices - (0198) — MM 0198 | CIGNA Coverage Update

TL;DR: Cigna Healthcare modified MM 0198 for continuous passive motion (CPM) devices, effective September 26, 2025. Both HCPCS codes under this policy — E0935 and E0936 — are now designated not medically necessary. Here's what your billing team needs to do.

Cigna Healthcare updated its CPM device coverage policy under policy code MM 0198 Cigna system. This change classifies E0935 (CPM device for knee use) and E0936 (CPM device for use other than the knee) as not medically necessary. If your practice or DME supplier bills these codes to Cigna, expect denials starting September 26, 2025.

Quick-Reference Table

Cigna CPM Device Coverage Criteria and Medical Necessity Requirements 2025

The core issue with the Cigna CPM device coverage policy is straightforward: Cigna has determined that CPM devices do not meet its medical necessity standard. That applies to both HCPCS E0935 and E0936. There's no tiered coverage, no exception pathway listed, and no indication that clinical documentation can overcome the designation.

Under MM 0198, Cigna is not covering CPM device use for post-surgical rehabilitation or for treating other conditions. That's the full scope — knee and non-knee applications alike are out. This isn't a narrow carve-out. It's a blanket not-medically-necessary designation across both device categories.

For billing teams, this means the Cigna CPM device coverage policy leaves no room for a successful medical necessity argument on claims submitted after the effective date of September 26, 2025. If you've been billing E0935 for post-TKA (total knee arthroplasty) recovery under Cigna plans, that pathway is now closed under this policy.

Prior authorization won't save these claims either. When a payer categorizes a service as not medically necessary at the policy level, prior auth approval doesn't override that designation. Don't assume a pre-auth for CPM equipment will protect your reimbursement. It won't.

If you have active Cigna patients receiving CPM therapy or post-surgical CPM rentals, review those cases now — before September 26, 2025. Any rental agreement or order initiated on or after the effective date carries serious reimbursement risk.

Cigna CPM Device Exclusions and Non-Covered Indications

MM 0198 places both CPM device codes in a single category: not medically necessary. That covers the full spectrum of clinical indications Cigna previously evaluated under this policy.

Knee CPM (E0935): This covers CPM devices designed specifically for knee rehabilitation — most commonly prescribed after total knee replacement or ligament repair surgery. Cigna's position is that the clinical evidence does not support medical necessity for these devices.

Non-Knee CPM (E0936): This covers CPM devices for other joints — shoulder, hip, elbow, and wrist are common applications. Same ruling, same outcome. Not medically necessary under Cigna billing guidelines.

This is a hard line. There's no language in the policy summary indicating that any subset of patients — high-risk, complex surgical cases, or otherwise — qualifies for coverage. If you're billing E0936 for post-shoulder surgery CPM under a Cigna plan, that claim is now a denial waiting to happen.

Coverage Indications at a Glance

Cigna CPM Device Billing Guidelines and Action Items 2025

The billing guidelines here are simple. This policy closes a coverage door. Your job is to make sure your team doesn't keep walking through it after September 26, 2025.

CPT, HCPCS, and ICD-10 Codes for CPM Devices Under MM 0198

The policy data for MM 0198 lists two HCPCS codes. No CPT codes and no ICD-10-CM codes are included in this policy. Do not bill E0935 or E0936 to Cigna expecting reimbursement after the effective date.

Not Medically Necessary HCPCS Codes

No CPT codes are listed under MM 0198. No ICD-10-CM codes are included in the policy data for this coverage determination.

A Note on DME Billing Context

CPM devices are durable medical equipment. They're typically billed by DME suppliers or hospital outpatient departments after joint surgery. This policy change sits squarely in the DME billing world, which means it touches a wide range of billing relationships — not just the ordering physician's practice.

Cigna's position on CPM isn't unique in the market. Several payers have moved in this direction, citing clinical evidence that CPM devices don't improve outcomes over standard physical therapy. The real issue here isn't the clinical debate — it's making sure your billing team and your DME partners are aligned before Cigna starts issuing denials.

If your organization bills both under a hospital outpatient department and through a separate DME supplier relationship, audit both channels. Claim denial volume can add up fast when two billing departments are independently submitting for the same not-covered service.