Notification



Notification Issue Date:



Medicare Advantage Policy

Title:Cold Therapy Devices
Policy #:MA05.035b

This policy is applicable to the Company’s Medicare Advantage products only. Policies that are applicable to the Company’s commercial products are accessible via a separate commercial policy database.


The Company makes decisions on coverage based on the Centers for Medicare and Medicaid Services (CMS) regulations and guidance, benefit plan documents and contracts, and the member’s medical history and condition. If CMS does not have a position addressing a service, the Company makes decisions based on Company Policy Bulletins. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable. Although the Medicare Advantage Policy Bulletin is consistent with Medicare’s regulations and guidance, the Company’s payment methodology may differ from Medicare.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.


This Policy Bulletin document describes the status of CMS coverage, medical terminology, and/or benefit plan documents and contracts at the time the document was developed. This Policy Bulletin will be reviewed regularly and be updated as Medicare changes their regulations and guidance, scientific and medical literature becomes available, and/or the benefit plan documents and/or contracts are changed.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's Evidence of Coverage.

A water-circulating cold pad with pump (E0218) is considered not medically necessary and, therefore, not covered.

A water bottle, ice cap or collar, and/or cold wraps (A9273) are not covered by the Company because they are items not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

Devices such as single-use packs that generate cold temperature by a chemical reaction, packs that contain gel or other material that can be repeatedly frozen, and simple containers into which ice water can be placed (A9999) are not covered by the Company because they are items not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.
Policy Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, a cold therapy device (e.g., a water-circulating pad with pump) is not eligible for payment under the medical benefits of the Company’s Medicare Advantage products because the device is considered not medically necessary and, therefore, not covered.

Subject to the terms and conditions of the applicable Evidence of Coverage, cold therapy devices (e.g., water bottle, ice cap or collar, and/or cold wraps, gel and/or cold packs) are not eligible for payment under the medical benefits of the Company’s Medicare Advantage products because these devices are not covered.

Description

A cold therapy device is one in which ice water is put into a reservoir and then circulated through a pad by means of gravity. There are also devices that work from an electric pump that circulates cold water through the pad, which can also be described as a water-circulating cold pad with pump.
References

Noridian Healthcare Solutions. Local Coverage Determination(L33735). Cold Therapy. [Noridian Healthcare Solutions Web site] Original: 10/01/2015. (Revised: 01/01/2017). Available at:https://med.noridianmedicare.com/web/jadme/policies/lcd/active. Accessed January 4, 2019.

Noridian Healthcare Solutions. Local Coverage Article(A52460) Cold therapy. Original: 10/01/2015. (Revised: 01/01/2017). Available at:https://med.noridianmedicare.com/web/jadme/policies/lcd/active. Accessed January 4, 2019.



Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)



A9273 Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type

E0218 Fluid circulating cold pad with pump, any type

THE FOLLOWING CODE IS USED TO REPRESENT DEVICES SUCH AS SINGLE-USE PACKS THAT GENERATE COLD TEMPERATURE BY A CHEMICAL REACTION, PACKS THAT CONTAIN GEL OR OTHER MATERIAL THAT CAN BE REPEATEDLY FROZEN, AND SIMPLE CONTAINERS INTO WHICH ICE WATER CAN BE PLACED WHICH ARE NONCOVERED, USE THE FOLLOWING CODE:

A9999 Miscellaneous DME supply or accessory, not otherwise specified


Revenue Code Number(s)

N/A

Coding and Billing Requirements






Policy History

MA05.035b
02/12/2020This policy has been reissued in accordance with the Company's annual review process.
02/13/2019 This policy has been reviewed and reissued to communicate the Company's continuing position on Cold Therapy Devices.
01/01/2019This version of the policy will become effective 01/01/2019.
The following HCPCS codes A9273 and E0218 have revised narratives

MA05.035a
04/11/2018This policy has been reviewed and reissued to communicate the Company's continuing position for cold therapy devices.
02/15/2017This policy has been reviewed and reissued to communicate the Company's continuing position for cold therapy devices.
10/26/2016This policy has been reviewed and reissued to communicate the Company's continuing position for cold therapy devices.
10/28/2015This policy will become effective 10/28/2015.

This policy has been reviewed and reissued to communicate the Company's continuing position for cold therapy devices.
08/26/2015This policy has been identified for an ad hoc HCPCS code update effective 08/26/2015
DELETED: A9270 Non-covered item or service
REPLACED WITH: A9999 Miscellaneous DME supply or accessory, not otherwise specific

MA05.035
01/01/2015This is a new policy.





Version Effective Date: 01/01/2019
Version Issued Date: 01/02/2019
Version Reissued Date: 02/14/2020