E1807 Adjust wrist extension devDynamic adjustable wrist extension only device, includes soft interface material
E1807 appears in 16 coverage policies from Aetna, Anthem, Centene, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Continuous Passive Motion (CPM) Machines (0010) | listed, no stance | Mar 5, 2026 | payer document |
| Aetna | Mechanical Stretching Devices for Contracture and Joint Stiffness (0405) Advance Dynamic ROM, Pro-glide dynamic ROM, SaeboReach, EZ Turnbuckle Orthosis | covered if criteria are met | Jun 30, 2026 | payer document |
| Aetna | Orthopedic Casts, Braces and Splints (0009) | covered if criteria are met | Jan 20, 2026 | payer document |
| Aetna | Orthopedic Casts, Braces and Splints (0009) | listed, no stance (range E1800-E1840) | Jan 20, 2026 | payer document |
| Anthem | Dynamic Low-Load Prolonged-Duration Stretch Devices (CG-DME-39) | covered if criteria are met | May 14, 2026 | payer document |
| Centene | Mechanical Stretching Devices for Joint Stiffness and Contracture (CP.MP.144) | covered if criteria are met | Oct 1, 2025 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (CS077.R) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (2026T0481BB) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (for Idaho Only) (CS077ID.D) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (for Kansas Only) (CS077KS.03) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (for Kentucky Only) (CS077KY.09) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (for Nebraska Only) (CS077NE.R) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (for New Jersey Only) (CS077NJ.P) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (for New Mexico Only) (CS077NM.E) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (for Ohio Only) (CS077OH.F) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (for Pennsylvania Only) (CS077PA.P) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Mechanical Stretching Devices (for Tennessee Only) (CS077TN.P) | listed, no stance | Dec 1, 2025 | payer document |
Prior authorization required or conditional in CO, IN, MS, NE, OH, VA.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.