K1036 — Supplies and accessories (e.g., transducer) for low frequency ultrasonic diathermy treatment device, per month
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Review and include the member's benefit contract or Summary Plan Description (SPD) when making coverage determinations.
- Use only the written coverage position in the Medical Policy for benefit determinations; do not rely on the presence or absence of codes in the document.
Key Coverage Criteria
- Illinois-only: For group or individual fully insured PPO, HMO, POS plans amended, delivered, issued, or renewed on or after 2025-01-01, cover therapy, diagnostic testing, and equipment necessary to increase quality of life for children clinically or genetically diagnosed with a disease/syndrome/disorder that includes low tone neuromuscular impairment, neurological impairment, or cognitive impairment.
- Noninvasive therapeutic ultrasound for treatment of musculoskeletal conditions to promote soft-tissue healing and provide pain relief.
- Ultrasonic diathermy (therapeutic ultrasound) to produce therapeutic heat in collagen‑rich tissues (muscles, tendons, ligaments) to facilitate soft tissue injury repair.
- Home-based continuous low-intensity therapeutic ultrasound (sustained acoustic medicine) for delivery of diathermy
- Alleviation of pain through deep heating of body tissues
- Treatment of muscle spasms
5 Active Policies
BCBSIL-THE801.039 — Stationary Ultrasonic Diathermy Devices
BCBSMT-THE801.039 — Stationary Ultrasonic Diathermy Devices
BCBSNM-THE801.039 — Stationary Ultrasonic Diathermy Devices
BCBSOK-THE801.039 — Stationary Ultrasonic Diathermy Devices
THE801.039 — Stationary Ultrasonic Diathermy Devices
Related Codes
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