Dynasplint denials in California external review

What the reviewers wrote

Where the denial was overturned

Nature of Statutory Criteria/Case Summary: An enrollee has requested authorization and coverage for Dynasplint for the right elbow. This patient is being treated for stiffness, or contracture, of the right elbow. He underwent right elbow reconstruction and right elbow excision of heterotopic ossification contracture. Occupational therapy notes conclude that he has plateaued with forearm supination despite active therapy. The patient’s supination fluctuated from 40-50 degrees for three weeks and he has not moved greater than 50 degrees of supination. Current, published peer-reviewed medical literature supports the use of a Dynasplint dynamic splint with noted improvement with range of motion with use of the device. Lindenhovius and colleagues concluded that post-traumatic elbow stiffness can improve with exercises and dynamic or static splinting over a period of six months to one year.

A 46-year-old male enrollee has requested reimbursement for use of a Dynasplint for the treatment of his contracture. Findings: Two physician reviewers found that the patient underwent palmer fasciectomy to release the contracture. Dynamic splinting devices such as the Dynasplint can be beneficial following this procedure. The use of the Dynasplint allows for a low-load, prolonged duration stretch to the finger joint and helps improve range of motion. It is an important adjunct to the rehabilitation process for patients such as this patient. The use of the Dynasplint in this setting was likely to have been more successful than hand therapy alone or a standard static splint.

Where the denial was upheld

Nature of Statutory Criteria/Case Summary: An enrollee has requested authorization and coverage for a Dynasplint. The Health Plan has denied this request indicating that the requested equipment is not medically necessary for treatment of the enrollee’s medical condition. The submitted documentation fails to demonstrate the medical necessity of the requested equipment. In this particular case, there is no documented evidence that this patient has undergone recent orthotic treatments. The records do not document home stretching exercises for the plantar fascia, physical therapy, local steroid injection to symptomatic painful heel area, over-the-counter orthotic therapy, or anti-inflammatory medications. All of the above-mentioned treatments are first-line standard of care treatments for plantar fasciitis.

A 23-year-old female enrollee has requested a Dynamic Adjustable Ankle Extension-Flexion Device (DynaSplint) for treatment of her foot pain status post surgery. Findings: Three physician reviewers found that there are some published case reports and case series related to the use of low-load prolonged-duration dynamic orthoses, such as the DynaSplint under review, for various joints in the medical literature (Richard, et al; Steffen and Mollinger). There are, however, no high-grade data in the published peer-reviewed medical literature supporting the efficacy of the DynaSplint for soft tissue or bony contractures at the ankle. Low-load prolonged-duration dynamic orthoses such as the DynaSplint are unsupported in the setting of contracture at the ankle following fracture.

These outcomes describe eligible cases completed through California DMHC’s Independent Medical Review program. They do not estimate the chance that an internal appeal, an external review in another jurisdiction, or your individual case will succeed. Use the record to identify evidence patterns involving Dynasplint, then check the rights and deadlines that apply to your plan.