LCD/NCD Portal

Local Coverage Determination (LCD) for Cold Therapy (L11552)

 

Contractor Information

Contractor Name

 

CGS Administrators, LLC opens in new window

 

 

Contractor Number

18003

 

Contractor Type

DME MAC

 

Jurisdiction

J - G

 

LCD Information

Document Information

 

 

LCD ID Number L11552

 

LCD Title Cold Therapy

 

Contractor's Determination Number COLD

 

AMA CPT/ADA CDT Copyright Statement

CPT only copyright 2002-2012 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.

Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association.

 

Alabama Arkansas Colorado Florida Georgia Louisiana Mississippi North Carolina New Mexico Oklahoma Puerto Rico

South Carolina Tennessee Texas

Virginia

Virgin Islands West Virginia

 

Oversight Region Region IV

 

 

DME Region LCD Covers Jurisdiction C

 

 

Original Determination Effective Date

For services performed on or after 04/01/1997 Original Determination Ending Date

 

 

Revision Effective Date

For services performed on or after 08/05/2011

 

Revision Ending Date

 

 

CMS National Coverage Policy None

 

Indications and Limitations of Coverage and/or Medical Necessity

 

For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements. For the items addressed in this local coverage determination, the criteria for "reasonable and necessary", based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following indications and limitations of coverage and/or medical necessity.

 

For an item to be covered by Medicare, a written signed and dated order must be received by the supplier before a claim is submitted. If the supplier bills for an item addressed in this policy without first receiving the completed order, the item will be denied as not reasonable and necessary.

 

A water circulating cold pad with pump (E0218) will be denied as not reasonable and necessary.

 

 

Coding Information

Bill Type Codes:

 

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

 

Revenue Codes:

 

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

CPT/HCPCS Codes

The appearance of a code in this section does not necessarily indicate coverage.

 

HCPCS MODIFIERS:

 

EY - No physician or other licensed health care provider order for this item or service

 

HCPCS CODES:

A9270 NON-COVERED ITEM OR SERVICE

A9273 HOT WATER BOTTLE, ICE CAP OR COLLAR, HEAT AND/OR COLD WRAP, ANY TYPE E0218 WATER CIRCULATING COLD PAD WITH PUMP

 

ICD-9 Codes that Support Medical Necessity Not specified.

AsteriskNoteText

 

Diagnoses that Support Medical Necessity Not specified.

ICD-9 Codes that DO NOT Support Medical Necessity Not specified.

 

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation

 

Diagnoses that DO NOT Support Medical Necessity

 

General Information

Documentations Requirements

Section 1833(e) of the Social Security Act precludes payment to any provider of services unless "there has been furnished such information as may be necessary in order to determine the amounts due such provider". It is expected that the patient's medical records will reflect the need for the care provided. The patient's medical records include the physician's office records, hospital records, nursing home records, home health agency records, records from other healthcare professionals and test reports. This documentation must be available upon request.

 

An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available upon request. Items billed before a signed and dated order has been received by the supplier must be submitted with an EY modifier added to each affected HCPCS code.

 

Refer to the Supplier Manual for more information on documentation requirements.

 

Appendices

 

Utilization Guidelines Refer to Indications and Limitations of Coverage and/or Medical Necessity.

 

Sources of Information and Basis for Decision Advisory Committee Meeting Notes

 

Start Date of Comment Period 12/01/1996

 

End Date of Comment Period 03/01/1997

 

Start Date of Notice Period 01/01/1997

 

Revision History Number 005

 

Revision History Explanation Revision Effective Date: 01/01/2011 INDICATIONS AND LIMITATIONS OF COVERAGE:

Revised: Preamble language HCPCS CODES AND MODIFIERS:

Added: Code A9273

 

03/01/2008 In accordance with Section 911 of the Medicare Modernization Act, this policy was transitioned to DME MAC CIGNA Government Services (18003) LCD L11517 from DME PSC TrustSolutions (77012) LCD L11517.

 

Revision Effective Date: 07/01/2007 INDICATIONS AND LIMITATIONS OF COVERAGE:

Removed: DMERC references DOCUMENTATION REQUIREMENTS:

Removed: DMERC references

 

06/01/2007 - In accordance with Section 911 of the Medicare Modernization Act of 2003, Virginia and West Virginia were transitioned from DME PSC TriCenturion (77011) to DME PSC TrustSolutions (77012).

 

03/01/2006 - In accordance with Section 911 of the Medicare Modernization Act of 2003, this policy was transitioned to DME PSC TrustSolutions (77012) from DMERC Palmetto GBA (00885).

 

Revision Effective Date: 07/01/2004 LMRP converted to LCD and Policy Article

 

Revision Effective Date: 04/01/2003 HCPCS CODES AND MODIFIERS:

Added: EY modifier

 

INDICATIONS AND LIMITATIONS OF COVERAGE:

Adds standard language concerning coverage of items without an order DOCUMENTATION REQUIREMENTS:

Adds standard language concerning use of EY modifier for items without an order.

 

08/05/2011 - The Jurisdiction C contractor adopted a new business name. This LCD revision only includes the change from CIGNA Government Services to CGS Administrators, LLC. No coverage information was included in this revision and no provider action is needed regarding this revision.

 

Reason for Change Maintenance (annual review with new changes, formatting, etc.)

 

 

Related Documents Article(s)

A19958 - Cold Therapy - Policy Article - Effective January 2011 opens in new window

 

LCD Attachments

There are no attachments for this LCD.

 

All Versions

 

Updated on 03/08/2012 with effective dates 08/05/2011 - N/A Updated on 08/04/2011 with effective dates 08/05/2011 - N/A Updated on 02/25/2011 with effective dates 01/01/2011 - 08/04/2011

 

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