K0627
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- A home cervical traction device is consideredmedically necessarywhenallof the following criteria (A, B, C and D) are met:
- The cervical traction device is an âover the doorâ design;and
- The individual has a musculoskeletal or neurologic impairment requiring traction equipment;and
- The appropriate use of a home cervical traction device has been demonstrated to the individual;and
- The individual is able to tolerate the device.
1 Active Policy
ANTHEM-CG-DME-05 — CG-DME-05 Cervical Traction Devices for Home Use
Related Codes
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