E0217, Water circulating heat pad with pump
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low 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.
- ICD-10 G50.0: Trigeminal neuralgia (covered if selection criteria are met)
- Use of CPT codes 64600 (destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) and 64620 (destruction by neurolytic agent, intercostal nerve) when furnished for the indications listed in this CPB.
- Selected ICD-10 diagnoses may be covered when selection criteria are met (examples listed in the CPB include G50.0 Trigeminal neuralgia; various joint effusion/hemarthrosis/pain codes; edema and swelling codes; pain codes), noting coverage is diagnosis- and criteria-dependent.
- Cryoanalgesia for the temporary relief of pain due to chronic refractory trigeminal neuralgia (subject to Appendix selection criteria).
9 Active Policies
ANTHEM-DME.00037, DME.00037 Cooling Devices and Combined Cooling/Heating Devices
L33784, Heating Pads and Heat Lamps
AETNA-CPB-0297, Cryoanalgesia and Therapeutic Cold
AETNA-CPB-0540, Heating Devices
DME101.000, DME Introduction
Related Codes
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