Active cooling devices (E0218, E0236) are considered not medically necessary. Study results suggest that the active cooling device is similar to ice packs, and there is inadequate evidence to demonstrate any benefit beyond ice packs. Effective January 26, 2009, a participating, preferred or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.

Passive cooling devices (A9270) are not considered durable medical equipment (DME). Therefore, they are not covered. Scientific literature is insufficient to document that the use of passive cooling systems is associated with a benefit beyond convenience. A participating, preferred, or network provider can bill the member for the denied service.

Description

Cold and/or compression therapy following surgery or musculoskeletal and soft tissue injury is an effective tool for reducing inflammation, pain, and swelling. Ice packs and various bandages and wraps are commonly used. In addition, a variety of continuous cooling devices are commercially available and can be broadly subdivided into those providing passive cold therapy and those providing active cold therapy using a mechanical device.

Passive cooling devices include, but are not limited to, the CryoCuff and the Polar Care Cub.

In active devices, a motorized pump both circulates cold water and may also provide pneumatic compression. Active cooling devices include, but are not limited to, the AutoChill device, the Hot/Ice Thermal Blanket, and the Game Ready Accelerated Recovery System.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Active cooling devices (E0218, E0236) and passive cooling devices (A9270) are considered not medically necesary.

National Blue Cross Blue Shield Association Medical Policy 1.01.26, Cooling Devices Used in the Outpatient Setting, 04/2004

DME MAC Jurisdiction A L5038