Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Cervical Traction Devices for In-home Use

Policy #:05.00.61f

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


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. 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.

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 Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

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

NOT MEDICALLY NECESSARY

The following types of cervical traction devices for home use are considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support their use in the diagnosis or treatment of illness or injury.
  • Cervical traction using a mechanical device (E0860) or pneumatic device (E0849, E0855)
  • Cervical traction applied via attachment to a headboard (E0840) or a freestanding frame (E0850)
  • Inflatable cervical traction devices (E0856)

Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, cervical traction for in-home use is
not eligible for payment under the medical benefits of the Company’s products because the service is
considered not medically necessary and, therefore, not covered.

Description

Cervical traction is commonly performed to relieve muscle spasms in the neck and shoulders, and to relieve the pain of pinched nerves in the neck. It can be administered by various techniques ranging from supine mechanical motorized or pneumatic traction, to seated traction using over-the-door pulleys with attached weights.

A Cochrane Collaboration systematic review of 7 randomized controlled trials (n=958) by Graham et al. (2011) assessed the effects of mechanical traction for neck disorders. Outcomes included pain, function, disability, global perceived effect, patient satisfaction, and quality of life measures. The review found no statistically significant difference between continuous traction and placebo traction in reducing pain or improving function for chronic neck disorders. The authors concluded that there was no evidence to clearly support or refute the use of either continuous or intermittent traction for neck disorders. Further studies are needed to assess the safety and efficacy of traction for neck disorders. There have been no additional studies since 2011.
References


Graham N , Gross A, Goldsmith CH, et al. Mechanical traction for neck pain with or without radiculopathy [Abstract]. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006408. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18646151. Accessed February 5, 2018.

North American Spine Society (NASS). Clinical guideline: Diagnosis and treatment of cervical radiculopathy from degenerative disorders. 2010. Available at: https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx. Accessed February 5, 2018.

Up-to-Date. Treatment of neck pain. 09/21/2017. Available at: http://www.uptodate.com/contents/treatment-of-neck-pain?source=search_result&search=cervical+non-surgical+spinal+decompression&selectedTitle=8%7E150 [via subscription only]. Accessed February 5, 2018.

Young IA, Michener LA, Cleland JA, et al. Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther. 2009;89(7):632-42. Epub 2009 May 21. Erratum in: Phys Ther. 2009;89(11):1254-5. Phys Ther. 2010;90(5):825.





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)

E0840 Traction frame, attached to headboard, cervical traction


E0849 Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible

E0850 Traction stand, freestanding, cervical traction

E0855 Cervical traction equipment not requiring additional stand or frame

E0856 Cervical traction device, with inflatable air bladder

E0860 Traction equipment, overdoor, cervical



Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References


Policy History

05.00.61f
03/14/2018The policy has been reviewed and reissued to communicate the Company’s continuing position on cervical traction for in-home use.

Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 11/01/2016
Version Issued Date: 11/01/2016
Version Reissued Date: 03/14/2018

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