Other Services
Chapter 8
Section 2.4
Cold Therapy Devices For
Home Use
Issue Date: April 19, 1983
Revision: C-1, March 10, 2017
1.0 DESCRIPTION
Cold therapy devices generally consist of a
picnic-type chest cooler in which is placed a quantity of ice and
water and into which is submerged a low voltage submersible pump
with an in-line thermometer and flow control valve. Water is circulated
by way of a plastic tube to a hollow rubber pad, which
is placed on the affected body part, and back to the water chest.
The device is sold under various trade names such as: Aqua K® pad,
polar care device, cryo-cuff or other similar designations.
2.0 POLICY
Cold therapy devices are excluded from coverage
as:
• Durable
Equipment (DE) and Durable Medical Equipment (DME)
with deluxe, luxury, or immaterial features; and
• Comfort and convenience
item.
They are not primarily
medical in nature, even though used to control pain, do not preclude
the use of analgesics in conjunction with the cold therapy, and
ultimately, except for the convenience of the commercial devices,
ice packs have been shown to serve the same purpose.
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