K0136
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For portable paraffin baths: documentation of a successful trial period of paraffin therapy and documentation that the member's condition is expected to be relieved by long-term use of the modality (e.g., severe rheumatoid arthritis of the hands).
- Requests for multiple heating devices must be supported (they are subject to medical review).
- Device/product specifications required: The heating pad must be certified by Underwriters Laboratories.
- Standard electric heating pad requirements: must have a fabric cover and a timing device for automatic shut-off; if heat-retaining material is included it must be contained in an enclosed pouch or bag in or around the heating elements.
Key Coverage Criteria
- Aetna considers passive hot plus cold therapy medically necessary for indications outlined in CPB 0297 - Cryoanalgesia and Therapeutic Cold.
- Aetna considers electric heating pads medically necessary durable medical equipment (DME) to relieve certain types of pain, decrease joint and soft tissue stiffness, relax muscles, or reduce inflammation.
- Aetna considers portable paraffin baths medically necessary DME for members who have undergone a successful trial period of paraffin therapy and the member's condition (e.g., severe rheumatoid arthritis of the hands) is expected to be relieved by the long-term use of this modality.
- General indications for therapeutic heat include pain, muscle spasm, contracture, tension myalgia, hematoma resolution, bursitis, tenosynovitis, fibrositis, fibromyalgia, superficial thrombophlebitis, and collagen vascular diseases.
- Paraffin baths are primarily used to treat contractures, particularly for patients with rheumatoid arthritis, hand contractures, or scleroderma.
- Hot packs (hydrocollator packs) are used to heat the body part prior to physical therapy (general therapeutic heat application).
1 Active Policy
AETNA-CPB-0540 — Heating Devices
Related Codes
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