E0221, Infrared heating pad system
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted.
- For DMEPOS base items requiring Written Order Prior to Delivery (WOPD), the supplier must have received a signed SWO (WOPD) before delivering the item to the beneficiary.
- When a WOPD is required for a base item that may have separately billed accessories, the WOPD must list the base item and may list the associated separately billed options/accessories/supplies prior to delivery.
- Suppliers are required to maintain proof of delivery (POD) documentation in their files and make POD available to the Medicare contractor upon request.
Key Coverage Criteria
- There are no covered indications for infrared therapy devices; CMS NCD 270.6 found no therapeutic effect and the device and related accessories are denied as not medically reasonable and necessary.
- 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.
- Paraffin baths are primarily used to treat contractures, particularly for patients with rheumatoid arthritis, hand contractures, or scleroderma.
9 Active Policies
DME101.045, Infrared Therapy Devices
L33825, Infrared Heating Pad Systems
AETNA-CPB-0540, Heating Devices
AETNA-CPB-0604, Infrared Therapy
AETNA-CPB-0729, Diabetic Neuropathy: Selected Treatments
Related Codes
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