CPM Machine denials: 39.8% overturned by independent reviewers
In 108 California IMR decisions from 2003 to 2026, reviewers overturned the plan 43 times (39.8%). In the last five years: 12.5% of 8. Denials reach IMR only when a member appeals all the way; read the caveats below before generalising.
By diagnosis
| Diagnosis category | Decisions | Overturned | Last 5 years |
|---|---|---|---|
| Orth/Musculoskeletal | 101 | 40.6% | 12.5% of 8 |
By year (last five)
| Year | Decisions | Overturned |
|---|---|---|
| 2021 | 2 | 0.0% |
| 2022 | 1 | 0.0% |
| 2023 | 2 | 0.0% |
| 2024 | 1 | 100.0% |
| 2025 | 1 | 0.0% |
| 2026 | 1 | 0.0% |
What the findings mention
| What the findings mention | Decisions | Overturned | All decisions here |
|---|---|---|---|
| Published evidence citedThe findings refer to peer-reviewed or published evidence. | 37 | 16.2% | 39.8% |
| Experimental or investigationalThe findings discuss whether the treatment is experimental. | 9 | 33.3% | 39.8% |
| Records did not supportThe findings say the documentation did not show what was needed (usually an upheld denial). | 9 | 0.0% | 39.8% |
Keyword matches on the reviewer’s findings, not causes. A tag that appears mostly in overturned decisions is worth documenting in an appeal; it is not a guarantee.
From recent overturned decisions
“The physician reviewer found that the patient has requested authorization and coverage for a continuous passive motion device. Experts noted `Judet quadricepsplasty is an effective method to treat knee extension contracture and improve knee range of motion (ROM). It should be performed by an experienced orthopedic surgeon and followed by physiotherapy with continuous passive motion (CPM). ` The combined treatment …”
“The patient has requested authorization and coverage for continuous passive motion (CPM). Researchers concluded that both CPM and conventional physical therapy are beneficial for the treatment of adhesive capsulitis in diabetic patients. However, the authors found that CPM provided distinctive improvements in the function and pain levels of adhesive capsulitis patients. This patient was diagnosed with left shoulder adhesive capsulitis. …”
“The patient’s parent has requested authorization and coverage for continuous passive motion (CPM) machine. Colleagues reported their findings suggested that CPM reduces arthrofibrosis requiring manipulation under anesthesia in pediatric patients after anterior cruciate ligament (ACL) reconstruction. The authors noted that future studies might better define the clinical utility of CPM in rehabilitation after this type of surgery in pediatric patients. …”
- California only: these are decisions by independent reviewers under California's IMR program (plans regulated by the Department of Managed Health Care). Other states and self-funded employer plans use different reviewers and rules.
- Selection: only denials that a member took all the way to IMR appear. Most denials are never appealed, and the ones that reach an external reviewer are not a random sample.
- Overturned means the reviewer disagreed with the plan; it does not mean the treatment worked or that a similar request will be approved.
- Argument tags are keyword matches on the reviewer's findings. They describe what the findings mention, not why the case was decided.
- Categories are DMHC's own labels (treatment sub-category and diagnosis category); 'Other' is a catch-all and is excluded from rankings.
Source: California Department of Managed Health Care, Independent Medical Review (IMR) Determinations, Trend (CHHS Open Data). Public California government data; Apellica's aggregates and tags are CC BY 4.0.
Questions
How often were CPM Machine denials overturned?
In 108 California IMR decisions from 2003 to 2026, reviewers overturned the plan 43 times (39.8%). In the last five years: 12.5% of 8.
What did the reviewers' findings mention in overturned cases?
The table on this page counts keyword matches in the findings: prior therapies tried, contraindications, guidelines cited, published evidence, whether the records supported the request. They describe what the findings say, not why the case was decided.
Does a California IMR result apply to my plan?
Only California plans regulated by the Department of Managed Health Care go to IMR. Other states and self-funded employer plans use different reviewers, but the reasoning is the same kind: criteria, documentation and alternatives. Use the findings as a guide to what to document.
Related: California appeal rights · California external-review reversal rate · The levers library · CSV
Independent reviewers reverse plans when the record answers the criteria. Upload the denial letter; a senior reviewer reads it within 24 hours and tells you in writing whether it can be appealed and how. $0 upfront, 10% of what is recovered, nothing if we do not recover. Not a law firm.