LCD/NCD Portal

L28614 HEATING PADS AND HEAT LAMPS

 

Region IV

DME

Jurisdiction C

 

04/01/2011

 

 

• For any item to be covered by Medicare, it must

o be eligible for a defined Medicare benefit category

o be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member

o Meet all other applicable Medicare statutory and regulatory requirements.

o 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.

o 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 standard electric heating pad (E0210) is covered to relieve certain types of pain, decrease joint and soft tissue stiffness, relax muscles, or reduce inflammation.

• A heating pad is not reasonable and necessary to treat pain due to peripheral neuropathy, including but not limited to diabetic neuropathy.

• It has not been established that a moist electric heating pad (E0215) or water circulating heat pad with pump (E0217) is reasonable and necessary compared to a standard electric heating pad (E0210)

o Therefore, if code E0215 or E0217 is provided it will be denied as not reasonable and necessary.

• Heating pads that do not meet the definitions list in the Coding Guidelines section of the related Policy Article and that are billed with code E1399 will be denied as not reasonable and necessary.

• Because a water circulating heating pad system is not medically necessary, a replacement pump (E0236) or pad (E0249, A9999) will be denied as not reasonable and necessary.

• The safety and effectiveness of using a heat lamp (E0200, E0205) in the home setting is not established. Claims for these items will be denied as not reasonable and necessary.

 

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:

 

A9273 HOT WATER BOTTLE, ICE CAP OR COLLAR, HEAT AND/OR COLD WRAP, ANY TYPE

A9999 MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED

E0200 HEAT LAMP, WITHOUT STAND (TABLE MODEL), INCLUDES BULB, OR INFRARED ELEMENT

E0205 HEAT LAMP, WITH STAND, INCLUDES BULB, OR INFRARED ELEMENT

E0210 ELECTRIC HEAT PAD, STANDARD

E0215 ELECTRIC HEAT PAD, MOIST

E0217 WATER CIRCULATING HEAT PAD WITH PUMP

E0225 HYDROCOLLATOR UNIT, INCLUDES PADS

E0236 PUMP FOR WATER CIRCULATING PAD

E0239 HYDROCOLLATOR UNIT, PORTABLE

E0249 PAD FOR WATER CIRCULATING HEAT UNIT, FOR REPLACEMENT ONLY

E1399 DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS

 

 

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".

o It is expected that the patient's medical records will reflect the need for the care provided.

o 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.

o 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.

o 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.

• There must be documentation in the patient’s medical record of the condition for which the heating device is being ordered.

o This must include appropriate history, including other therapeutic modalities that have been used, and physical examination. This information must be available upon request.

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

 

Sources of Information and Basis for Decision

 

Harris: Kelley’s Textbook of Rheumatology. 7th edition. Saunders; 2005

 

Perret D, Rim J, Cristian A. A Geriatrician’s Guide to the Use of the Physical Modalities in the Treatment of Pain and Dysfunction. The Medical Clinics of North America 2006; 22: 331-354

 

Stanos S, McLean J, Rader L. Physical Medicine Rehabilitation Approach to Pain. The Medical Clinics of North America 2007; 91:57-95

 

Tepperman P, Devlin M. The Therapeutic Use of Local Heat and Cold. Canadian Family Physician 1986; 32:1110-1114

 

A48140 - Heating Pads and Heat Lamps – Policy Article - Effective April 2011

 

Local Coverage Determination (LCD) for Heating Pads and Heat Lamps (L28614)