Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut DME.00047 Rehabilitative Devices with Remote Monitoring Form

Effective Date

06/28/2023

Last Reviewed

05/11/2023

Original Document

  Reference



DME.00047 Rehabilitative Devices with Remote Monitoring

Subject:

Description/Scope

This document addresses the use of rehabilitative devices with remote monitoring and adjustment capabilities intended to evaluate and improve muscle strength and range of motion (ROM) while reporting session data to the individual’s provider.

Note: Benefit exclusions regarding exercise equipment may apply.

Note: This document does not address mobile device-based health management applications. For more information regarding such service, please see:

  • CG-ANC-08 Mobile Device-Based Health Management Applications
  • CG-DME-10 Durable Medical Equipment

Position Statement

Investigational and Not Medically Necessary:

The use of rehabilitative devices with remote monitoring or adjustment capabilities is considered investigational and not medically necessary for all indications.