Notification



Notification Issue Date:



Medicare Advantage Policy

Title:Heating Pads and Heat Lamps
Policy #:MA05.029b

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.

MEDICALLY NECESSARY

A standard electric heating pad (E0210) is considered medically necessary and, therefore, covered to relieve certain types of pain, decrease joint and soft tissue stiffness, relax muscles, or reduce inflammation.

NOT MEDICALLY NECESSARY

A standard electric heating pad is considered not medically necessary and, therefore, not covered to treat pain due to peripheral neuropathy, including but not limited to diabetic neuropathy.

A moist electric heating pad (E0215) or water circulating heat pad with pump (E0217) is considered not medically necessary and, therefore, not covered because it has not been established that they are medically necessary when compared to a standard electric heating pad (E0210). Because a water circulating heating pad system (E0217) is not medically necessary, a replacement pump (E0236) or pad (E0249, A9999) is considered not medically necessary and, therefore, not covered.

The use of a heat lamp (E0200, E0205) is considered not medically necessary and, therefore, not covered in the home setting because the safety and effectiveness have not been established.

Heating pads that do not meet the definitions listed in the Coding and Billing Requirements section of this policy are considered not medically necessary and, therefore, not covered.

Infrared heating pad systems (E0221) are considered not medically necessary and, therefore, not covered because there are no indications for which these devices have been demonstrated to have any therapeutic effect. Also, replacement pads for infrared heading pad systems (A4639) are considered not medically necessary and, therefore, not covered.

NOT COVERED

A nonelectric heating pad or wrap (A9273) is not covered by Company because it is an item not covered by Medicare. Therefore, it is not eligible for reimbursement consideration.

Hydrocollator units (E0225, E0239) is not covered by Company because these units are considered institutional equipment and not appropriate for home use. Therefore, they are not eligible for reimbursement consideration.

REQUIRED DOCUMENTATION

The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports. This policy is consistent with Medicare's documentation requirements, including the following required documentation:

PRESCRIPTION (ORDER) REQUIREMENTS
Before submitting a claim to the Company, the supplier must have on file a timely, appropriate, and complete order for each item billed that is signed and dated by the professional provider who is treating the member. Requesting a provider to sign a retrospective order at the time of an audit or after an audit for submission as an original order, reorder, or updated order will not satisfy the requirement to maintain a timely professional provider order on file.

PROOF OF DELIVERY
Medical record documentation must include a contemporaneously prepared delivery confirmation or member’s receipt of supplies and equipment. The medical record documentation must include a copy of delivery confirmation if delivered by a commercial carrier and a signed copy of delivery confirmation by member/caregiver if delivered by the DME supplier/provider. All documentation is to be prepared contemporaneous with delivery and be available to the Company upon request.

CONSUMABLE SUPPLIES
The durable medical equipment (DME) supplier must monitor the quantity of accessories and supplies an individual is actually using. Contacting the individual regarding replenishment of supplies should not be done earlier than approximately seven days prior to the delivery/shipping date. Dated documentation of this contact with the individual is required in the individual’s medical record. Delivery of the supplies should not be done earlier than approximately five days before the individual would exhaust their on-hand supply.

If required documentation is not available on file to support a claim at the time of an audit or record request, the durable medical equipment (DME) supplier may be required to reimburse the Company for overpayments.
Policy Guidelines

This policy is consistent with Medicare's coverage criteria. The Company's payment methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, a standard electric heating pad is covered under the medical benefits of the Company’s Medicare Advantage products when the medical necessity criteria listed in this medical policy are met. However, services that are identified in this policy as not medically necessary or noncovered are not eligible for coverage or reimbursement by the Company.

Description

Please refer to the Billing and Coding Requirements section of this policy for a description of heating pads and heat lamps and the applicable Healthcare Common Procedural Coding System (HCPCS) code for each item.
References

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD).270.6: Infrared therapy devices. [CMS Web site]. 10/24/06. Available at: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=315&ncdver=1&bc=AAAAgAAAAAAAAA%3d%3d&. Accessed January 11, 2019.

Noridian Healthcare Solutions. Local Coverage Article(A52477). Infrared heating pad systems. [Noridian Healthcare Solutions Web site]. Original: 10/01/2015. (Revised: 01/01/2017). Available at: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52477&ver=5&Cntrctr=389&name=&DocType=Active&DocStatus=Active&ContrVer=1&CntrctrSelected=389*1&s=9&LCntrctr=139*1&bc=AhAAAAMAAAAAAA%3d%3d&. Accessed January 11, 2019.

Noridian Healthcare Solutions. Local Coverage Article(A52502). Heating pads and heat lamps. [Noridian Healthcare Solutions Web site]. Original: 10/01/2015. (Revised: 01/01/2017). Available at:
https://med.noridianmedicare.com/documents/2230703/7218263/Heating+Pads+and+Heat+Lamps/59b1a576-01f0-401a-a4f7-249bacfd280a. Accessed January 11, 2019.

Noridian Healthcare Solutions. Local Coverage Determination(L33825). Infrared heating pad systems. [Noridian Healthcare Solutions Web site]. Original: 10/01/2015. (Revised: 01/01/2017). Available at: https://med.noridianmedicare.com/documents/2230703/7218263/Infrared+Heating+Pad+Systems+LCD+and+PA/2546d114-d385-498b-8159-da1320873d4b. Accessed January 11, 2019.

Noridian Healthcare Solutions. Local Coverage Determination(L33784). Heating pads and heat lamps. Original: 10/01/2015. (Revised: 01/01/2017). Available at: https://med.noridianmedicare.com/documents/2230703/7218263/Heating+Pads+and+Heat+Lamps/59b1a576-01f0-401a-a4f7-249bacfd280a. Accessed January 11, 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)



MEDICALLY NECESSARY

E0210 Electric heat pad, standard

NOT MEDICALLY NECESSARY

A4639 Replacement pad for infrared heating pad system, each
E0200 Heat lamp, without stand (table model), includes bulb, or infrared element
E0205 Heat lamp, with stand, includes bulb, or infrared element
E0215 Electric heat pad, moist
E0217 Water circulating heat pad with pump
E0221 Infrared heating pad system
E0236 Pump for water circulating pad
E0249 Pad for water circulating heat unit, for replacement only

THE FOLLOWING CODE IS CONSIDERED NOT MEDICALLY NECESSARY WHEN REPORTED FOR REPLACEMENT PADS USED WITH A WATER CIRCULATING HEAD PUMP SYSTEM:

A9999 Miscellaneous DME supply or accessory, not otherwise specified

NOT COVERED

A9273 Cold or Hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type
E0225 Hydrocollator unit, includes pads
E0239 Hydrocollator unit, portable


Revenue Code Number(s)

N/A

Coding and Billing Requirements

A standard electric heating pad (E0210) 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 (E0215) 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.

A water circulating heat pad with pump (E0217) 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 Laboratories.

A hydrocollator unit (E0225, E0239) is a container which is filled with water and then heated. Bags of silicone dioxide or other material are placed in the heated water. These packs/pads are then applied to the body part over towels. They are used to heat the body part prior to physical therapy.

Code E0249 is a durable replacement pad used with a water circulating heat pump system (E0217). It is made of rubber, heavy plastic, or durable fabric. It can be cleaned and is designed for long term use. A replacement pad made of other material that is designed for shorter term use must be billed using code A9999 (Miscellaneous DME supply or accessory, not otherwise specified).

An infrared heating pad system (E0221) 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. Replacement pads are coded A4639.

Cross References




Policy History

MA05.029b
02/12/2020This policy has been reissued in accordance with the Company's annual review process.
02/13/2019The policy has been reviewed and reissued to communicate the Company's continuing position on Heating Pads and Heat Lamps.
01/01/2019This version of the policy will become effective 01/01/2019. The following HCPCS code A9273 has revised narratives

MA05.029a
02/07/2018This version of the policy will become effective 02/07/2018. Revised policy number MA05.029a was issued as a result of the department's annual review process to communicate the Company’s continuing position on Heating Pads and Heat Lamps.

MA05.029
02/15/2017The policy has been reviewed and reissued to communicate the Company’s continuing position on Heating Pads and Heat Lamps.

Existing durable medical equipment documentation requirements, in accordance with Medicare, are now included with examples.
02/03/2016The policy has been reviewed and reissued to communicate the Company’s continuing position on Heating Pads and Heat Lamps.

Existing durable medical equipment documentation requirements, in accordance with Medicare, are now included with examples.
06/10/2015The policy has been reviewed and reissued to communicate the Company’s continuing position on Heating Pads and Heat Lamps.

Existing durable medical equipment documentation requirements, in accordance with Medicare, are now included with examples
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