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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