E0231, Non-contact wound warming device (temperature control unit, ac adapter and
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The CPB references clinical assessment methods used in studies (e.g., clinical signs and symptoms [CSS], NERDS/STONEES/UPPER/LOWER checklists, microbiological swabs, biopsies) but does not mandate these as documentation requirements for coverage.
- The CPB does not specify formal documentation requirements or required medical-record elements for coverage determination.
- No documentation requirements are specified in this excerpt.
- Microbiological culture results are required to identify bacterial species and antibiotic sensitivities when such information is needed for management.
Key Coverage Criteria
- Noncontact warming therapy (NNWT) and low-frequency ultrasound therapy for wounds are not medically necessary due to insufficient evidence of efficacy.
- Noncontact real-time fluorescence wound imaging for bacterial presence is not medically necessary due to insufficient evidence of safety/efficacy.
- MolecuLight, a hand-held device, for point-of-care fluorescence imaging of wounds
- Noncontact, nonthermal, low-frequency ultrasound therapy for the treatment of wounds and all other indications (e.g., bacterial infections, deep tissue pressure injury, and femoral artery thrombosis)
- Warm-Up Active Wound Therapy, also known as noncontact normothermic wound therapy (NNWT) and warming therapy
- None — The CPB states the following are considered experimental and investigational because effectiveness has not been established: MolecuLight (hand-held device) for point-of-care fluorescence imaging of wounds; noncontact, nonthermal, low-frequency ultrasound therapy for the treatment of wounds and all other indications; Warm-Up Active Wound Therapy (noncontact normothermic wound therapy / NNWT / warming therapy).
10 Active Policies
AMBETTER-CP.MP.139, Low-Frequency Ultrasound and Noncontact Normothermic Wound Therapy
UHC-POL-noncontact-warming-therapy-ultrasound-therapy-wounds, Noncontact Warming Therapy, Ultrasound Therapy, and Fluorescence Imaging for Wounds
AETNA-CPB-0372, Wound Imaging and Noninvasive Wound Therapy
DME101.050, Noncontact Warming Therapy and Fluorescence Imaging for Wounds
BCBSIL-DME101.050
Related Codes
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