E0218 — Fluid circulating cold pad with pump, any type
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted.
- For DMEPOS items requiring a Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD before delivery; the WOPD must list the base item and may list separately billed accessories/supplies.
- Proof of delivery (POD) documentation must be maintained by the supplier and made available to the Medicare contractor upon request.
- Claims must be correctly coded per CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, and DME MAC articles and must meet the LCD-related Standard Documentation Requirements article.
Key Coverage Criteria
- Item must be eligible for a defined Medicare benefit category to be covered.
- Item must be reasonable and necessary for diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
- Item must meet all other applicable Medicare statutory and regulatory requirements, including LCD-related Standard Documentation Requirements and LCD-related Policy Article.
- 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.
5 Active Policies
L33735 — Cold Therapy
J19
AETNA-CPB-0297 — Cryoanalgesia and Therapeutic Cold
AETNA-CPB-0540 — Heating Devices
ANTHEM-DME.00037 — DME.00037 Cooling Devices and Combined Cooling/Heating Devices
REGENCE-DME07 — Cooling Devices Used in the Home Setting
Related Codes
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