Cigna modified MM 0198 for continuous passive motion (CPM) devices, effective September 26, 2025. Both HCPCS codes covered by this policy — E0935 and E0936 — are now designated Not Medically Necessary.
Cigna Healthcare updated its CPM device coverage policy under policy code MM 0198, and the position is unambiguous: the payer considers CPM devices not medically necessary across the board. Whether your team bills E0935 for knee-specific CPM devices or E0936 for other joints, Cigna is not paying. If your durable medical equipment billing includes CPM rentals or purchases for Cigna members, this update changes your reimbursement picture significantly.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Continuous Passive Motion (CPM) Devices — MM 0198 |
| Policy Code | MM 0198 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Orthopedic surgery, physical medicine & rehabilitation, DME suppliers, home health |
| Key Action | Remove E0935 and E0936 from Cigna charge capture and update denial workflows before September 26, 2025 |
Cigna CPM Device Coverage Criteria and Medical Necessity Requirements 2025
The core of MM 0198 in Cigna's system is straightforward, and not in a good way for billing teams. Cigna Healthcare's coverage policy designates CPM devices as not medically necessary. That applies to both HCPCS E0935 (knee CPM devices) and E0936 (CPM devices for joints other than the knee).
There is no tiered criteria here — no pathway where a patient meets certain clinical conditions and suddenly gets coverage. The policy does not carve out exceptions for post-surgical rehabilitation, total knee arthroplasty, or any other indication. The designation is categorical.
This matters because CPM devices have historically occupied a gray zone in payer policy. Some payers covered them under narrow post-operative criteria, others didn't. Cigna is drawing a hard line. If you've been billing E0935 or E0936 to Cigna on the assumption that clinical documentation could support a medical necessity argument, that argument is gone as of September 26, 2025.
On prior authorization: even if your team historically sought prior authorization for CPM devices before ordering, prior auth approval does not guarantee claim payment. A prior auth under a policy that classifies the service as not medically necessary can still result in a claim denial. Don't treat a prior auth approval as a green light if the underlying coverage policy says Not Medically Necessary — talk to your compliance officer if you're navigating active authorizations that cross this effective date.
Cigna CPM Device Exclusions and Non-Covered Indications
The policy summary does not parse out individual clinical indications with separate coverage statuses. It treats CPM devices as a class. Both E0935 and E0936 fall under the "Considered Not Medically Necessary" designation.
That means CPM devices for post-surgical knee rehabilitation — the most common use case that drives E0935 billing — are not covered. CPM devices for shoulder, hip, elbow, or other joint rehabilitation under E0936 are not covered either.
If your orthopedic surgery practice or DME supplier has been billing CPM devices for Cigna members after total knee replacement, ACL reconstruction, or joint manipulation procedures, those claims will deny under MM 0198. Document that clearly in your internal billing guidelines so your team stops submitting claims that will not pay.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| CPM device for knee (post-surgical or other use) | Not Medically Necessary | E0935 | No coverage exceptions documented in policy |
| CPM device for joints other than knee | Not Medically Necessary | E0936 | No coverage exceptions documented in policy |
Cigna CPM Device Billing Guidelines and Action Items 2025
The effective date is September 26, 2025. That gives your team a defined window to act. Here's what to do before and after that date.
| # | Action Item |
|---|---|
| 1 | Pull your E0935 and E0936 claim history for Cigna now. Identify how many claims you're submitting monthly for CPM devices billed to Cigna Healthcare members. That's your financial exposure number. Know it before the effective date hits. |
| 2 | Update your charge capture and order entry workflows before September 26, 2025. Remove E0935 and E0936 from any Cigna-specific charge sets or DME order templates that route to Cigna billing. If a provider orders a CPM device for a Cigna member, the billing team needs to know immediately that no reimbursement path exists. |
| 3 | Audit open prior authorizations for CPM devices with Cigna. If you have any pending or approved prior auths for E0935 or E0936 that will extend past September 26, 2025, review them with your compliance officer. Prior auth approval does not override a Not Medically Necessary designation. You may be delivering equipment that Cigna will deny regardless of auth status. |
| 4 | Update your claim denial workflows and remark code tracking. After September 26, 2025, E0935 and E0936 claims to Cigna will likely return with a denial citing medical necessity. Make sure your denial management queue categorizes these correctly — they are policy-driven denials, not documentation gaps. Appealing them without a policy change is a waste of time and resources. |
| 5 | Communicate this change to your referring orthopedic surgeons and physical medicine providers. If physicians on your referral network are ordering CPM devices expecting Cigna coverage for their patients, they need to know that coverage is gone. A simple heads-up prevents patient billing disputes downstream. |
| 6 | If CPM devices are a significant part of your DME billing mix, talk to your billing consultant. This is a clean Not Medically Necessary designation, but if your practice has been building post-operative protocols around CPM device use for Cigna patients, you may need to revisit those protocols from both a clinical and financial standpoint. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Continuous Passive Motion Devices Under MM 0198
The policy data for MM 0198 includes two HCPCS codes. No CPT codes or ICD-10 diagnosis codes are listed in this policy.
Not Medically Necessary HCPCS Codes
| Code | Type | Description | Status |
|---|---|---|---|
| E0935 | HCPCS | Continuous passive motion exercise device for use on knee only | Not Medically Necessary |
| E0936 | HCPCS | Continuous passive motion exercise device for use other than knee | Not Medically Necessary |
Both codes are durable medical equipment codes used for CPM device rentals and purchases. E0935 is the code your team uses for knee CPM — by far the higher-volume code given how frequently these devices have been ordered after total knee arthroplasty and other knee procedures. E0936 covers all other joints.
No covered codes exist under this policy. There is no partial coverage, no exception pathway, and no additional HCPCS or CPT codes listed that would indicate a covered alternative within the same policy.
What This Means for Your Revenue Cycle
This is a blunt policy. Cigna Healthcare isn't narrowing criteria or adding documentation requirements — it's closing the door entirely on CPM device reimbursement under MM 0198.
The real issue here is that CPM billing has been inconsistent across payers for years. Some payers covered E0935 for short-term post-op knee use with appropriate documentation. Others didn't. Billing teams that work across multiple payers have had to maintain separate rules for CPM devices depending on the payer. With this update, Cigna Healthcare removes itself from the "covered with criteria" category and lands firmly in the "not covered, full stop" column.
If you're a DME supplier, this is higher exposure than if you're a hospital-based billing team. DME suppliers often hold the equipment, bill the insurer, and absorb the denial risk. Know your volume. Know your Cigna patient mix. Act before September 26, 2025.
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