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TRICARE Policy Manual 6010.63-M, April 2021
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Chapter 8
Section 2.4
Cold Therapy Devices For Home Use
Issue Date:  April 19, 1983
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.
2.1  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.
2.2  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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