TRICARE Policy Manual 6010.60-M, April 1, 2015 Other Services Chapter 8 Section 2.4 Cold Therapy Devices For Home Use Issue Date: April 19, 1983 Authority: 32 CFR 199.2, 32 CFR 199.4(d)(3)(ii), (g)(1), (g)(64), and 32 CFR 199.5(d)(7) Revision: C-1, March 10, 2017 1.0 DESCRIPTIONCold 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 POLICYCold 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. - END -