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
- 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.
- Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this policy.
- When billing, providers must use the most appropriate codes as of the effective date of the submission. Claims submitted for services that are not accompanied by covered code(s) under this policy will be denied as not covered.
- In the event of a conflict, a customer's benefit plan document always supersedes the information in the Cigna / ASH Medical Coverage Policy. Benefits are ultimately determined by the terms of the applicable benefit plan document and may require consideration of: (1) the terms of the applicable benefit plan document in effect on the date of service; (2) any applicable laws/regulations; (3) any relevant collateral source materials including Cigna-ASH Medical Coverage Policies; and (4) the specific facts of the particular situation.
Key Coverage Criteria
- 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.
- Home traction therapy is not medically necessary for treating low back and neck disorders with or without radiculopathy due to insufficient evidence of efficacy.
4 Active Policies
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
CIGNA-CPG265, Home Traction Devices - Cervical and Lumbar
Related Codes
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