E0205 — Heat lamp, with stand, includes bulb, or infrared element
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Suppliers must maintain proof of delivery (POD) documentation in their files and make POD available to the Medicare contractor upon request.
- A Standard Written Order (SWO) must be communicated to the supplier before claim submission; for DMEPOS base items requiring a Written Order Prior to Delivery (WOPD) the supplier must have a signed SWO/WOPD before delivery.
- When a DMEPOS base item requires a WOPD and associated options/accessories/supplies are separately billed, the WOPD must list the base item and may list the separately billed associated items prior to delivery.
- Suppliers and providers must follow the LCD-related Standard Documentation Requirements Article, the LCD-related Policy Article, the Supplier Manual, and DME MAC web publications for additional documentation and payment rules prior to reimbursement.
Key Coverage Criteria
- An item is covered only if it is in a defined Medicare benefit category, is reasonable and necessary for diagnosis/treatment or to improve function of a malformed body member, and meets applicable Medicare statutory and regulatory requirements.
- A standard electric heating pad (HCPCS E0210) is covered when used to relieve pain, decrease joint or soft tissue stiffness, relax muscles, or reduce inflammation.
- Aetna considers passive hot plus cold therapy medically necessary for indications outlined in CPB 0297 - Cryoanalgesia and Therapeutic Cold.
- Aetna considers electric heating pads medically necessary durable medical equipment (DME) to relieve certain types of pain, decrease joint and soft tissue stiffness, relax muscles, or reduce inflammation.
- Aetna considers portable paraffin baths medically necessary DME for members who have undergone a successful trial period of paraffin therapy and the member's condition (e.g., severe rheumatoid arthritis of the hands) is expected to be relieved by the long-term use of this modality.
- General indications for therapeutic heat include pain, muscle spasm, contracture, tension myalgia, hematoma resolution, bursitis, tenosynovitis, fibrositis, fibromyalgia, superficial thrombophlebitis, and collagen vascular diseases.
8 Active Policies
L33784 — Heating Pads and Heat Lamps
J19
AETNA-CPB-0656 — Phototherapy for Acne
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BCBSNM-DME101.000 — Durable Medical Equipment (DME) Reference List
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