Home Traction Devices - Cervical and Lumbar - (CPG265)

Home cervical and lumbar traction devices—including gravity-assisted/inversion and devices that permit ambulation—are considered experimental, investigational and/or unproven for any indication and are not covered (HCPCS: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941; all ICD‑10 codes apply). Claims must be submitted with appropriate covered diagnosis/procedure codes per the policy and the applicable benefit plan document and laws (which supersede this policy); claims billed with non-covered codes will be denied.

"Home cervical and/or lumbar traction devices, including gravity-assisted traction devices, are considered experimental, investigational and/or unproven for any indication."

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