E0941 — Gravity assisted traction device, any type
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- No specific documentation requirements for home traction therapy are stated in the policy.
- Policy instruction: "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. In the event of a conflict, the member specific benefit plan document governs."
- Policy instruction: "Before using this policy, please check the member specific benefit plan document and any applicable federal or state mandates."
- Where coverage for care or services does not depend on specific circumstances, reimbursement will only be provided if a requested service(s) is submitted in accordance with the relevant guidelines and criteria outlined in this policy, including covered diagnosis and/or procedure code(s) outlined in the Coding Information section of this policy.
Key Coverage Criteria
- None. (Policy conclusion: Home traction therapy is unproven and not medically necessary for treating low back and neck disorders with or without radiculopathy.)
- Exact policy statement: "Home traction therapy is unproven and not medically necessary for treating low back and neck disorders with or without radiculopathy due to insufficient evidence of efficacy."
- Home cervical and/or lumbar traction devices, including gravity-assisted traction devices, are considered experimental, investigational and/or unproven for any indication.
4 Active Policies
CIGNA-CPG265 — Home Traction Devices - Cervical and Lumbar - (CPG265)
UHC-POL-home-traction-therapy — Home Traction Therapy
UMR-POL-UMR-home-traction-therapy — Home Traction Therapy
SUREST-POL-SUREST-home-traction-therapy — Home Traction Therapy
Related Codes
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