Mechanical Stretching Devices

Revised: March 31, 2025

Overview

Mechanical stretching devices, or extension and flexion devices, are used for the treatment of joint contractures in lower and upper extremities. These devices are intended to maintain or restore range of motion and replace some therapy-directed sessions through consistent and frequent joint mobilization in an outpatient setting or in the home.

Eligible Providers

The following are eligible to provide mechanical stretching devices:

· Federally qualified health centers

· Home health agencies

· Hospitals

· Indian Health Services

· Medical suppliers

· Rural health clinics

Eligible Members

Mechanical stretching devices are covered for eligible Medical Assistance or MinnesotaCare members who:

· suffer from joint stiffness and are not responding to, or as a complement to, physical or occupational therapy during the subacute injury or postoperative period (for example, at least three weeks but less than four months after injury or surgery); or

· have a documented history of motion stiffness or loss in a joint, have had a surgery or procedure done to improve motion to that joint, and are in the acute postoperative period following a second or subsequent surgery or procedure.

Covered Services

Codes: E1800, E1802-E1805, E1807, E1808, E1810, E1812-E1815, E1820, E1822, E1823, E1825-E1830, E1840
MHCP covers dynamic splinting systems for eligible members. Dynamic splinting systems for extension and/or flexion are covered for ankles (E1815, E1822, and E1823), elbows (E1800, E1803, and E1804), fingers (E1825 to E1827), forearms (E1802), knees (E1810, E1812 to E1814), shoulders (E1840), toes (E1828 to E1830), or wrists (E1805, E1807, and E1808).

Noncovered Services

MHCP does not cover the following static progressive stretch (SPS) or patient-actuated serial stretch (PASS) devices (codes E1801, E1806, E1811, E1816, E1818, E1821, E1831, E1832, and E1841) because they are considered investigative and substantive research is lacking.

Authorization

Authorization is always required for mechanical stretching devices. Submit authorization requests and required documentation to the Medical Review Agent.

Documentation for authorization requests must include:

· Member’s diagnosis

· Order

· A face-to-face evaluation by a physical or occupational therapist

· Clinical history of member’s joint stiffness and prior treatments, including physical or occupational therapy, any surgeries, and other procedures

· Treatment plan, including baseline measurements of range of motion limitations

Billing

Providers are responsible to coordinate services. Refer to the Billing Policy Overview section of the MHCP Provider Manual for general billing information.

Bill dynamic splinting systems using MN–ITS 837P Professional. Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetics, Orthotics, and Augmentative Devices MN–ITS user manual for general billing requirements and guidance when submitting claims.

· Use modifier NU for purchases.

· Use modifiers KH, KI, KJ, and RR for rentals.

Definitions

Dynamic splinting systems: Low-load prolonged-duration stretch (LLPS) devices are spring-loaded, adjustable devices used to treat joint contractures. LLPS devices are designed to maintain low-load prolonged stretch while members are asleep or at rest.

Static progressive stretch (SPS) devices: SPS devices hold the joint in a set position but permit manual modification of the joint angle and may allow for active motion without resistance. SPS devices are used for multiple short sessions daily with the joint angle progressively advanced at each session. These devices virtually allow the member to duplicate physical or occupational therapy by therapists who apply a new positional stretch multiple times throughout the session.

Patient-actuated serial stretch (PASS) devices: PASS devices are used in the home chiefly to address scar tissue around the joint. PASS devices allow resisted active and passive motion within a limited range. They apply a low- to high-level load to the joint, using tensioning system that can be adjusted by the member.