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
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.