0540 Heating Devices (1) - Aetna
Transcript of 0540 Heating Devices (1) - Aetna
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Heating Devices
Policy History
Last Review
03/10/2020
Effective: 07/03/2001
Next
Review: 01/14/2021
Review History
Definitions
Additional Information
Clinical Policy Bulletin
Notes
Number: 0540
Policy *Please see amendment for Pennsylvania Medicaid at the end of this CPB.
I. Aetna considers electric heating pads medically
necessary durable medical equipment (DME) to relieve
certain types of pain, decrease joint and soft tissue
stiffness, relax muscles, or reduce inflammation. A
heating pad is not of proven value to treat pain due to
peripheral neuropathy, including but not limited to
diabetic neuropathy.
II. Aetna considers passive hot plus cold therapy medically
necessary for indications outlined
CPB 0297 - Cryoanalgesia and Therapeutic Cold
in (../200_299/0297.html)
.
III. Aetna considers heat lamps unproven because the
safety of heating lamps in the home setting has not
been established.
IV. Aetna considers portable paraffin baths medically
necessary DME for members who have undergone a
successful trial period of paraffin therapy and the
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member's condition (e.g., severe rheumatoid arthritis of
the hands) is expected to be relieved by the long-term
use of this modality. Standard (non-portable) paraffin
baths are not considered appropriate for home use.
V. Aetna considers mechanical heated water-circulating
pads and pumps experimental and investigational
because they have not been proven to produce
outcomes superior to standard electric heating pads.
VI. Aetna considers infrared heating pad systems
experimental and investigational because they have not
been proven to have a therapeutic effect on any
conditions for which they were developed. See
also CPB 0604 - Infrared Therapy (../600_699/0604.html).
VII. Aetna considers the PainShield MD low-frequency
ultrasonic diathermy device for home use experimental
and investigational because its effectiveness has not
been established.
VIII. Aetna does not cover any of the following heating
devices because they are institutional equipment that is
not appropriate for home use:
▪ Hydrocollator units (hot packs); or
▪ Microwave diathermy devices; or
▪ Short-wave diathermy devices; or
▪ Ultrasound devices; or
These modalities must always be performed by or under the
supervision of a qualified physical therapist.
IX. The following heating devices do not meet Aetna's
contractual definition of DME because they are not
primarily medical in nature and are normally of use in
the absence of illness or injury:
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▪ Heat and massage foam cushion pads; or
▪ Hot water bottles; or
▪ Portable room heaters.
Note: Usually, no more than 1 heating device is considered
medically necessary for each medical condition. Requests for
multiple heating devices are subject to medical review.
Background
Heating devices (fomentation devices) are used for a variety of
indications including joint pain and muscle spasms. Application
of heat results in the production of hyperemia, induction of
reflex vasodilation, and acceleration of metabolic
processes. The application of heat may ease pain by dilating
the blood vessels and decreasing painful stiffness of soft
tissues surrounding the injured area. General indications for
therapeutic heat include pain, muscle spasm, contracture,
tension myalgia, hematoma resolution, bursitis, tenosynovitis,
fibrositis, fibromyalgia, superficial thrombophlebitis, and
collagen vascular diseases. General contraindications and
precautions for therapeutic heat include acute inflammation,
trauma, or hemorrhage; bleeding disorders; temperature
insensitivity; inability to communicate or respond to pain; poor
thermal regulation (e.g., from neuroleptics); malignancy;
edema; ischemia; atrophic skin; and scar tissue.
Hot Packs
Hot packs, also known as hydrocollator packs, warm tissue by
conduction. They typically consist of canvas bags filled with
silicon dioxide that absorbs many times its own weight in
water. Hot packs are immersed in a hot water bath, and are
removed from the bath when needed, wrapped in 6 to 8 layers
of toweling or an insulating cover, and applied to the patient.
They are used to heat the body part prior to physical therapy.
To avoid scalding, excess water should be drained from the
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pack and the covering towels or pad should be checked for
excessive dampness. The packs cool slowly and can remain
warm for 30 or more mins. Medicare considers hydrocollator
units as non-covered institutional equipment.
Heating Pads
A heating pad is a pad that has an electric or infrared heating
element and is used to apply topical heat to the skin.
A standard electric heating pad is a flexible device containing
electric resistive elements producing heat. It must have a
fabric cover. It must have a timing device for automatic shut-
off. It may include heat-retaining material (e.g., gel, fluid,
vegetable matter). If so, the heat retaining materials must be
contained in an enclosed pouch or bag in or around the
heating elements. The heating pad must be certified by
Underwriters Laboratories. A heating pad that includes a cover
or other element that utilizes water vapor (humidity) drawn
from the air to create moisture when heated is billed using this
code.
A moist electric heating pad is a flexible device containing
electric resistive elements producing heat. It must have a
fabric cover. It must have a timing device for automatic shut-
off. It must have a component that absorbs and retains liquid
water. The water containing element must be protected from
contact with the electrical components and the water must be
in direct contact with the skin on application. The heating pad
must be certified by Underwriters Laboratories. A cover or
other element that utilizes water vapor (humidity) drawn from
the air to create moisture when heated does not meet the
definition of this code. Water must be added to the device to
meet the description of this code.
Because electric heating pads do not cool spontaneously, use
should be limited to 20 mins to avoid the risk of burns. There
is no evidence that the use of circulating-water heating pads or
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moist electric heating pads provide superior outcomes, in
terms of enhancing recovery of function, compared to standard
electric heating pads. According to Medicare DME MAC
policy, it has not been established that a moist electric heating
pad is reasonable and necessary compared to a standard
electric heating pad.
According to Durable Medical Equipment Medicare
Administrative Contractor (DME MAC) policy, standard electric
heating pads are necessary to relieve certain types of pain,
decrease joint and soft tissue stiffness, relax muscles, or
reduce inflammation. DME MAC policy states that a heating
pad is not reasonable and necessary to treat pain due to
peripheral neuropathy, including but not limited to diabetic
neuropathy.
In uncomplicated cases, heat treatments of this type, as well
as paraffin baths, may not require the skills of a physical
therapist.
Water Circulating Heating Pad with Pump
A water circulating heat pad with pump is a flexible pad
containing a series of channels through which water is
circulated by means of an electrical pumping mechanism. The
water is heated in an external reservoir. The pump, pad, and
all accessories needed for the pad to be functional are
included in the code. The device must be certified by
Underwriters Laboratory.
A pad for water circulating heat unit, for replacement only is a
durable replacement pad used with a water circulating heat
pump system. It is made of rubber, heavy plastic, or durable
fabric. It can be cleaned and is designed for long term use.
According to Medicare DME MAC policy, it has not been
established that a water circulating heat pad with pump is
reasonable and necessary compared to a standard electric
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heating pad. The policy states that, because a water-
circulating heating pad system is not medically necessary, a
replacement pump or pad is not reasonable and necessary.
Heat Lamps
A heat lamp is a lamp that emits infrared light and produces
topical heat to the skin. Heat lamps warm tissues by
conversion (i.e., by converting radiant energy to heat). Heat
lamps often use 250-Watt incandescent bulbs and are usually
placed about 40 to 50 cm from the patient. Because ordinary
incandescent light bulbs produce large amounts of infrared
energy, special infrared sources (e.g., quartz, tungsten) are
seldom necessary. Heating rates and maximum temperatures
are controlled by adjusting the distance between the lamp and
the patient. Heat lamps may be preferred over hot packs
where the patient is difficult to position or can not tolerate
pressure. Heat lamps may also be easier to use than hot
packs. According to DME MAC policy, the safety and
effectivness of using a heat lamp in the home setting is not
established.
Paraffin Baths
A paraffin bath is a container that holds and heats a mixture of
mineral oil and paraffin into which the individual may either
continuously immerse the treated body part (such as the hand
or foot) for 20-30 minutes or repetitively dip and remove the
treated area from the paraffin.
Paraffin baths are primarily used to treat contractures,
particularly for patients with rheumatoid arthritis, hand
contractures, or scleroderma. The typical paraffin bath
consists of a container filled with approximately a 1:7 mixture
of mineral oil and paraffin maintained at 52°C to 54°C. Although
paraffin-oil mixtures can be heated in a double boiler or stove,
small commercial units are available for home use, which have
the advantages of ease of use and increased safety. The
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patient may either continuously immerse the treated part for 20
to 30 minutes, or may repetitively dip and remove the treated
area from the paraffin.
Ultrasound
Ultrasound is sound above the limits of human hearing. The
therapeutic effects of ultrasound result from the conversion of
sound to heat energy. Ultrasound diathermy typically employs
frequencies between 0.8 and 1 MHz.
Ultrasound diathermy is considered a deep heating modality in
that most absorption occurs far beneath the skin. It is most
commonly used to treat tendonitis and bursitis,
musculoskeletal pain, degenerative arthritis, and contractures.
Maximal heating may be limited by deep tissue factors and not
by skin tolerance. Ultrasound may be applied directly by
placing the applicator on the skin, or indirectly by immersing
the body part and applicator in a water-filled container.
Because of the importance of appropriate technique and
inherent dangers, ultrasound diathermy should be applied by a
trained attendant and the devices are not appropriate for
unsupervised home use.
Short-Wave Diathermy
Short-wave diathermy uses radio waves to heat tissue
conversively; tissue is heated by the actions of a rapidly
alternating electrical field. Because of the inherent risks
involved in application of this deep heating modality, short-
wave diathermy machines are inappropriate for unsupervised
use at home.
Microwave Diathermy
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Microwave diathermy involves the use of microwaves for
heating tissues, and offers an advantage over short-wave
diathermy in treating small areas in that they can be relatively
easily focused. However, microwaves generally do not
penetrate tissue as deeply as short-waves.
Microwave diathermy has been used primarily to heat
relatively superficial muscles and joints. Microwave diathermy
is used relatively rarely, and indications for which microwaves
would be appropriate often are treated with superficial heat,
short-wave diathermy, or ultrasound. Because of the
importance of appropriate application technique and the
inherent risks of this deep heating modality, microwave
diathermy machines are inappropriate for unsupervised home
use.
Infrared Heating Pads
An infrared heating pad system consists of a pad or pads
containing mechanisms (for example, luminous gallium
aluminum arsinide diodes) that generate infrared (or near
infrared) light and a power source. According to DME
MAC policy, there are no indications for which these devices
have been demonstrated to have any therapeutic effect. DME
MAC policy considers these devices and any related
accessories not medically reasonable and necessary. As a
heating device, infrared heating pads have not been shown to
be more effective than electric heating pads and hot packs,
despite their greater cost.
PainShield MD Low-Frequency Ultrasonic Diathermy Device for Home Use
The PainShield MD is an ultrasound (US) device used to apply
heat to the tissues in the body with a transducer/applicator that
is incorporated into a patch that adheres to the skin, as does a
bandage. It is used to generate continuous surface acoustic
waves US at 90 KHz, through a reusable applicator/transducer
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that covers an area of about 6 cm2. The small applicator
allows treatment of less accessible body parts such as the
heel and wrist. The device include a transducer/applicator,
rechargeable battery powered driver unit and a cable that
connects the driver to the transducer. The PainShield MD is
indicated for the treatment of selected medical conditions such
as pain relief, muscle spasm and joint contractures.
Rosenblum and colleagues (2014) noted that transcutaneous
oxygen pressure (TcPO2) less than 30 mm Hg at the toe leads
to local tissue hypoxia and non-healing wounds. Studies
regularly illustrated that TcPO2 values are strong predictors of
healing and can accurately demonstrate altered levels when
extremities have restricted blood flow. These researchers
examined the effectiveness of surface acoustic wave (SAW) in
ischemic feet on local tissue oxygenation. A total of 10
patients, ranging from 40 to 75 years of age and suffering from
critical limb ischemia (CLI) were selected from a vascular
surgery clinic to undergo evaluation with a PainShield SAW
Patch device (NanoVibronix Inc, Melville, NY). Patients were
treated once with 96 KHz of SAW for 30 mins. All patients had
an ankle brachial index (ABI) of less than 0.4 mm Hg. Two
patients (patients 1 and 8) had necrosis of at least 2 toes on
the affected limb and were given the device for nightly use for
1 month. Through usage of SAW there was a significant
increase in all patients' saturation values. The recorded
baseline in both patients with necrotic toes almost doubled and
during usage there was still a measurable increase in oxygen
saturation. In both of these patients the subjective pain
measures dropped significantly. Pain, as assessed by the
visual analog scale (VAS), dropped from 9 to 2 for patient 1
and from 8 to 3 for patient 8. Patient 1 went from 5
methadone treatments per day to only 1 per day starting in
week 3. Patient 8 did not change their pain medication
regimen. The authors concluded that surface acoustic waves
as delivered in this study had a positive effect on tissue
oxygenation and saturation in ischemic feet. In lower
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extremities that were not surgical candidates or were either in
the pre- or post-surgical environment, an SAW patch device
was a good therapy in elevating the extremities' O2 saturation.
Appendix
General indications for therapeutic heat include pain, muscle
spasm, contracture, tension myalgia, hematoma resolution,
bursitis, tenosynovitis, fibrositis, fibromyalgia, superficial
thrombophlebitis, and collagen vascular diseases.
General contraindications and precautions for therapeutic heat
include acute inflammation, trauma, or hemorrhage; bleeding
disorders; temperature insensitivity; inability to communicate or
respond to pain; poor thermal regulation (e.g., from
neuroleptics); malignancy; edema; ischemia; atrophic skin;
and scar tissue.
CPT Codes / HCPCS Codes / ICD-10 Codes
Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":
Code Code Description
Other CPT codes related to the CPB:
97010 Application of a modality to one or more areas;
hot or cold packs
97018 paraffin bath
97024 diathermy (eg, microwave)
97026 infrared
97035 ultrasound, each 15 minutes
HCPCS codes covered if selection criteria are met:
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Code Code Description
A4265 Paraffin, per lb.
E0210 Electric heat pad, standard
E0215 Electric heat pad, moist
E0235 Paraffin bath unit, portable
HCPCS codes not covered for indications listed in the CPB:
A9273 Hot water bottle, ice cap or collar, heat and/or
cold wrap, any type
E0200 Heat lamp, without stand (table model),
includes bulb, or infrared element
E0205 Heat lamp, with stand, includes bulb, or infrared
element
E0217 Water circulating heat pad with pump
E0218 Water circulating cold pad with pump
E0221 Infrared heating pad system
E0225 Hydrocollator unit, includes pads
E0236 Pump for water circulating pad
E0239 Hydrocollator unit, portable
E0249 Pad for water circulating heat unit; for
replacement only
K1004 Low frequency ultrasonic diathermy treatment
device for home use, includes all components
and accessories [PainShield MD]
ICD-10 codes covered if selection criteria are met (too many to list):
ICD-10 codes not covered for indications listed in the CPB:
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Code Code Description
E08.40 -
E08.49
E08.610,
E09.40 -
E09.49
E09.610,
E10.40 -
E10.49
E10.610,
E11.40 -
E11.49
E11.610,
E13.40 -
E13.49
E13.610
Diabetes with neurological manifestations
G90.01 -
G90.9
Disorders of autonomic nervous system
G99.0 Autonomic neuropathy in diseases classified
elsewhere
The above policy is based on the following references:
1. Ayling J, Marks R. Efficacy of paraffin wax baths for
rheumatoid arthritic hands. Physiotherapy. 2000;86
(4):190-201.
2. Basford JR. Physical Agents. In: Rehabilitation
Medicine: Principles and Practice. 2nd ed. JA DeLisa,
ed. Philadelphia, PA: JB Lippincott Co.; 1993; Ch 18:
404-424.
3. Brosseau L, Yonge KA, Welch V, et al. Thermotherapy
for treatment of osteoarthritis. Cochrane
Database Syst Rev. 2003;(4):CD004522.
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4. French SD, Cameron M, Walker BF, et al. Superficial
heat or cold for low back pain. Cochrane
Database Syst Rev. 2006;(1):CD004750.
5. Greene J. Microwave diathermy: The invisible healer.
FDA Consum. 1979;13(1):7-11.
6. Guffey JS, Knaust ML. The use and efficacy of
ultrasound. Rehab Manag. 1997;10(6):44, 48-50, 115.
7. NHIC, Corp. Heating pads and heat lamps. Local
Coverage Artilce No. A 48071. Durable Medical
Equipment Medicare Administrative Contractor (DME
MAC) Jurisdiction A. Hingham, MA: NHIC; revised May
1, 2013.
8. NHIC, Corp. Heating pads and heat lamps. Medicare
Local Coverage Determination (LCD) No. L28480.
Durable Medical Equipment Medicare
Administrative Contractor (DME MAC) Jurisdiction A.
Hingham, MA: NHIC; revised October 31, 2014.
9. Rivest M, Quirion-de Girardi C, Seaborne D, et al.
Evaluation of therapeutic ultrasound devices:
Performance stability over 44 weeks of clinical use.
Physiother Can. 1987;39(2):77-86.
10. Rosenblum JI, Gazes MI, Greenberg N. Surface acoustic
wave patch therapy affects tissue oxygenation in
ischemic feet. Wounds. 2014;26(10):301-305.
11. U.S. Department of Health and Human Services,
Health Care Financing Administration (HCFA). Durable
medical equipment reference list. Medicare Coverage
Issues Manual §60-9. Baltimore, MD: HCFA; 1999.
12. U.S. Department of Health and Human Services,
Health Care Financing Administration (HCFA).
Medicare Carriers Manual §§2100.1, 2210.3. Baltimore,
MD: HCFA; 1999.
13. Welch V, Brosseau L, Casimiro L, et al. Thermotherapy
for treating rheumatoid arthritis. Cochrane
Database Syst Rev. 2002:(2):CD002826.
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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan
benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial,
general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care
services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors
in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely
responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is
subject to change.
Copyright © 2001-2021 Aetna Inc.
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AETNA BETTER HEALTH® OF PENNSYLVANIA
Amendment to Aetna Clinical Policy Bulletin Number: 0540 Heating Devices
There are no amendments for Medicaid.
annual 03/01/2021
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