Elbows

Elbow Orthosis

Coverage Determination:

  • Treatment of Non-fixed Contracture of the Elbow
  • Elbow Extension
  • Increasing Range of Motion

SoftPro Static Gel Elbow
OrthoPro ROM Elbow
DynaPro Flex Elbow

SoftPro Static Gel Elbow

  • Product Description: Static EO Elbow Orthosis
  • Product Treats: Elbow flexion contracture
  • Product Utilization: Patient has pain along with decreased ROM and expectations are progressive extension in conjuction with passive ROM therapy. This is defined as ROM provided by caregiver.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper arm and lower arm circumference. Approximately 4 inches above and below the elbow joint.
  • Coding: L3760 Prefabricated EO with Joints, ICD Code 718.42 Contracture of upper arm joint
  • Required Documentation: Therapy, Nursing or Physician notes stating the patient has the above diagnosis and requires a static EO for treatment of Elbow contracture. Telephone order is required for dispensing and must state RT/LT/ Bilateral EO.
  • Adjunct Products: Gel Elbow pad is included with the product. There is also an option ROM Exerciser available not billable to Medicare or Insurance.

OrthoPro ROM Elbow

  • Product Description: ROM EO Elbow Orthosis
  • Product Treats: Elbow flexion contracture
  • Product Utilization: Patient has contracture with the ability to perform some active ROM. The ROM hinge allows for control of extension and flexion with ROM. The expectation is extension through ROM while controlling flexion contracture.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper arm and lower arm circumference. Approximately 4 inches above and below the elbow joint.
  • Coding: L3760 Prefabricated EO with Joints, ICD Code 718.42 Contracture of upper arm joint
  • Required Documentation: Therapy, Nursing or Physician notes stating the patient has the above diagnosis and requires a ROM EO for treatment of Elbow contracture. Telephone order is required for dispensing and must state RT/LT/Bilateral EO.
  • Adjunct Products: Gel Elbow pad is included with the product.

DynaPro Flex Elbow

  • Product Description: Dynamic Elbow Orthosis
  • Product Treats: Elbow flexion contracture
  • Product Utilization: Patient has contracture with some ROM, minimal pain and expectation of significant increase in ROM with low load prolonged stretch. This will encompass a majority of long term care residents with progressive expected outcome.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper arm and lower arm circumference. Approximately 4 inches above and below the elbow joint.
  • Coding: L3760 Prefabricated EO with Joints, ICD Code 718.42 Contracture of upper arm joint
  • Required Documentation: Therapy, Nursing or Physician notes stating the patient has the above diagnosis and requires a Dynamic EO for treatment of Elbow contracture. Telephone order is required for dispensing and must state RT/LT/ Bilateral EO.
  • Adjunct Products: Gel Elbow pad is included with the product.

NeuroFlex Restorative Elbow
NeuroFlex Restorative Elbow for Extensor Tone

NeuroFlex Restorative Elbow

  • Product Description: Dynamic Elbow Orthosis
  • Product Treats: Elbow flexion contracture
  • Product Utilization: Patient has contracture with some ROM, Tone, minimal pain and expectation of significant increase in ROM with low load prolonged stretch. This will encompass a majority of long term care residents with progressive expected outcome.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper arm and lower arm circumference. Approximately 4 inches above and below the elbow joint.
  • Coding: L3760 Prefabricated EO with Joints, ICD Code 718.42 Contracture of upper arm joint
  • Required Documentation: Therapy, Nursing or Physician notes stating the patient has the above diagnosis and requires a Dynamic EO for treatment of Elbow contracture. Telephone order is required for dispensing and must state RT/LT/ Bilateral EO.
  • Adjunct Products: Elbow pad is included with the product.

NeuroFlex Restorative Elbow for Extensor Tone

  • Product Description: Dynamic Elbow Orthosis
  • Product Treats: Elbow flexion contracture along with extensor tone
  • Product Utilization: Patient has contracture with some ROM, Extensor tone, minimal pain and expectation of significant increase in ROM with low load prolonged stretch. This will encompass a majority of long term care residents with progressive expected outcome.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper arm and lower arm circumference. Approximately 4 inches above and below the elbow joint.
  • Coding: L3760 Prefabricated EO with Joints, ICD Code 718.42 Contracture of upper arm joint
  • Required Documentation: Therapy, Nursing or Physician notes stating the patient has the above diagnosis and requires a Dynamic EO for treatment of Elbow contracture. Telephone order is required for dispensing and must state RT/LT/ Bilateral EO.
  • Adjunct Products: Elbow pad is included with the product.

Care Rest Elbow (L3760)
Care Bendable Elbow

Care Rest Elbow (L3760)

  • Light weight, treatment/correction of elbow flexion contractures, post-surgery or injury additionally for patients with flexor tone. Single upright adjustable joint. Available in 3 sizes (S,M,L).

Care Bendable Elbow

  • Bendable orthosis used for gradual extension of non-fixed contractures. Great as a resting splint, stablizing or for wound care positioning. Often used to treat mild contractures where space is limited.