CG-DME-05 Cervical Traction Devices for Home Use

This policy addresses home cervical traction devices. Coverage is medically necessary only for over‑the‑door cervical traction devices when all criteria are met: the patient has a musculoskeletal or neurologic impairment requiring traction, has been instructed in appropriate use, and can tolerate the device. Devices are not covered when these criteria are not met.

"A home cervical traction device is consideredmedically necessarywhenallof the following criteria (A, B, C and D) are met:"

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