1. (1) Indications and limitations of coverage and medical appropriateness: The Division may cover some dynamic adjustable extension/flexion devices for a covered condition when all of the following conditions are met:

   1. (a) As an adjunct to physical therapy for clients with signs and symptoms of persistent joint stiffness in the sub-acute injury or post-operative period (> 3 weeks but < 4 months after injury or surgical procedure) when the device is applied and managed under the direct supervision of a physical therapist;
   2. (b) As an adjunct to physical therapy in the acute post-operative period for clients who are undergoing additional surgery to improve the range of motion of a previously affected joint when the device is managed under the direct supervision of a physical therapist;
   3. (c) For this episode, the device has not been billed to the Division with a current procedure terminology (CPT) code, healthcare common procedure coding system (HCPCS) code, or diagnosis code by any other healthcare provider;
   4. (d) Reimbursement is limited to a maximum of four (4) months per episode;
   5. (e) Reimbursement is on a month-to-month rental basis only.

2. (2) Documentation requirements:

   1. (a) Submit medical records that support the conditions of coverage, as specified in this rule, have been met, including the treatment plan from the physical therapist;

   2. (b) The treatment plan shall include:

      1. (A) Baseline measurements (pre-intervention measurements) of range of motion (ROM) limitations;
      2. (B) Weekly ROM measurements with documented 10 degree improvement.

3. (3) Refer to Table 122-0678 — Dynamic Adjustable Extension/Flexion Devices for HCPCS codes.

   [ED. NOTE: To view attachments referenced in rule text, click here for PDF copy.]

Statutory/Other Authority

ORS 413.042 & 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 87-2025, amend filed 12/09/2025, effective 12/09/2025
DMAP 11-2016, f. 2-24-16, cert. ef. 3-1-16
DMAP 15-2007, f. 12-5-07, cert. ef. 1-1-08
OMAP 47-2006, f. 12-15-06, cert. ef. 1-1-07
OMAP 44-2004, f. & cert. ef. 7-1-04
OMAP 21-2003, f. 3-26-03, cert. ef. 4-1-03
OMAP 8-2002, f. & cert. ef. 4-1-02
OMAP 32-2001, f. 9-24-01, cert. ef. 10-1-01
OMAP 4-2001, f. 3-30-01, cert. ef. 4-1-01
OMAP 37-2000, f. 9-29-00, cert. ef. 10-1-00