0540 heating devices (1) - aetna

Heating Devices - Medical Clinical Policy Bulletins | Aetna of 14

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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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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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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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0540 heating devices (1) - aetna

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