E0855 — Cervical traction equipment not requiring additional stand or frame
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 covered items.
- For DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD before delivery; the WOPD should list the base item and may list separately billed associated options/accessories/supplies.
- Suppliers must maintain proof of delivery (POD) documentation and make it available to the Medicare contractor upon request.
- Claims must adhere to CMS HCPCS coding guidelines and the LCD-related Standard Documentation Requirements Article, LCD-related Policy Article, and Supplier Manual as applicable for additional documentation requirements.
Key Coverage Criteria
- HCPCS E0849 or E0855 (chin halter variants) are covered when the general coverage criteria are met and the beneficiary has a diagnosis of temporomandibular joint (TMJ) dysfunction with prior treatment for the TMJ condition.
- Cervical traction devices (E0840, E0849, E0850, E0855, E0860) are covered only if the beneficiary has a musculoskeletal or neurologic impairment that requires traction equipment.
- Coverage requires that the appropriate use of the home cervical traction device has been demonstrated to the beneficiary and the beneficiary tolerated the selected device.
- HCPCS E0860 (over-the-door cervical traction mechanism) is covered when the general coverage criteria (impairment requiring traction and device demonstration/tolerance) are met.
- HCPCS E0849 or E0855 are covered when the general coverage criteria are met and the beneficiary has distortion of the lower jaw or neck anatomy (e.g., radical neck dissection) such that a chin halter cannot be utilized.
- HCPCS E0849 or E0855 are covered when the general coverage criteria are met and the treating practitioner documents medical necessity for greater than 20 pounds of cervical traction in the home setting.
6 Active Policies
L33823 — Cervical Traction Devices
J19
CIGNA-CPG265 — Home Traction Devices - Cervical and Lumbar - (CPG265)
ANTHEM-CG-DME-05 — CG-DME-05 Cervical Traction Devices for Home Use
UHC-POL-home-traction-therapy — Home Traction Therapy
UMR-POL-UMR-home-traction-therapy — Home Traction Therapy
Related Codes
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