R22.30 — Localized swelling, mass and lump, unspecified upper limb
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation should support duration of treatment consistent with policy guidance (the maximum duration of treatment is generally four weeks).
- Coding/billing note: there is no specific CPT/HCPCS code for fluidotherapy; related CPT codes referenced in the policy include 97036 (Hubbard tank, each 15 minutes) and 97113 (aquatic therapy with therapeutic exercises).
- Policy states fluidized therapy is a physical therapy modality subject to the physical therapy guidelines and any applicable plan benefit limits for physical therapy.
- Aetna will cover only the professional charges of a physical therapist or other recognized, licensed providers for fluidized therapy and other physical therapy modalities that require direct, one-on-one, patient contact. Please check benefit plan descriptions.
Key Coverage Criteria
- Aetna considers fluidized therapy medically necessary for the treatment of acute or subacute traumatic or non-traumatic musculoskeletal disorders of the extremities.
- Use of fluidized therapy dry heat is an acceptable alternative to other heat therapy modalities in reducing pain, edema, and muscle spasm from acute or subacute traumatic or non-traumatic musculoskeletal disorders of the extremities.
1 Active Policy
AETNA-CPB-0450 — Fluidized Therapy (Fluidotherapy)
Related Codes
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