E0231 — Non-contact wound warming device (temperature control unit, ac adapter and power cord) for use with warming card and wound cover
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- No explicit documentation requirements are listed in this policy for warming therapy, ultrasound therapy, or fluorescence imaging devices.
- Policy reminder: when deciding coverage, reference the member specific benefit plan document: "When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan." (Instructions for Use)
- Applicable Codes section: inclusion of a code does not imply right to reimbursement or guarantee claim payment; medical necessity and benefit coverage are determined by the member-specific benefit plan (implies that documentation to support medical necessity would be required per that plan).
- 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.
Key Coverage Criteria
- None — Warming therapy or noncontact normothermic wound therapy (NNWT) and low frequency ultrasound therapy are unproven and not medically necessary for treating wounds due to insufficient evidence of efficacy.
- None — Noncontact real-time fluorescence wound imaging for bacterial presence is unproven and not medically necessary due to insufficient evidence of safety and/or 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
AETNA-CPB-0372 — Noncontact Normothermic/Nonthermal Wound Therapy and Noncontact Fluorescence Imaging of Wounds
UHC-POL-noncontact-warming-therapy-ultrasound-therapy-wounds — Noncontact Warming Therapy, Ultrasound Therapy, and Fluorescence Imaging for Wounds
UMR-POL-UMR-noncontact-warming-therapy-ultrasound-therapy-wounds — Noncontact Warming Therapy, Ultrasound Therapy, and Fluorescence Imaging for Wounds
Related Codes
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