Coding Code Description CPT
E0218 Water circulating cold pad with pump
E0236 Pump for water circulating pad
E0650 Pneumatic Compressor, nonsegmental home model
E0651 Pneumatic compressor, segmental home model without calibrated gradient pressure
E0652 Pneumatic compressor, segmental home model with calibrated gradient pressure
E1399 Durable medical equipment, miscellaneous
Applying ice is known as cold therapy and helps reduce pain and swelling. Using a bandage or wrap to apply light pressure is known as compression therapy. Cold and compression therapy after surgery or injury is very effective in reducing inflammation, pain, and swelling. Using ice packs and bandages is the usual way of applying cold and compression therapy. A number of cooling devices have been developed. Some are manual while others use a small motor to cool water and move it within the wrap. Sometimes cooling devices are used in place of an ice pack and bandage. Cooling devices, including the types that add compression, are not medically necessary. Published medical studies do not show cooling devices provide better health results than ice packs and bandages.
Note: The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria. The rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for providers. A provider can be a person, such as a doctor, nurse, psychologist, or dentist. A provider also can be a place where medical care is given, like a hospital, clinic, or lab. This policy informs them about when a service may be covered.
Cooling Devices Medical Necessity
Circulating and noncirculating Circulating and noncirculating cooling devices, with or without compression, used in the outpatient setting are considered not medically necessary.
Refer to benefit or contract language when assessing whether passive cooling devices would be considered durable medical equipment.
Circulating Cooling Devices
In active, circulating cooling devices, a motorized pump circulates chilled water and may also provide pneumatic compression.
* The AutoChill® device, which may be used with a CryoCuff®, consists of a pump that automatically exchanges water from the cuff to the cooler, eliminating the need for manual water recycling.
* CTM™ 5000 and cTreatment are computer-controlled devices that provide cooling at a specific (11°C, or 52ºF) and continuous temperature.
* Game Ready™ Accelerated Recovery System is an active circulating cooling device combined with a pneumatic component. The system consists of various soft wraps and a computercontrol unit to circulate the water through the wraps and provide intermittent pneumatic compression.
* Hilotherm® Clinic circulates cooled water through preshaped thermoplastic polyurethane facial masks for use after different types of facial surgery.
* Hot/Ice Thermal Blanket is another circulating cooling device. It consists of 2 rubber pads connected by a rubber hose to the main cooling unit. Fluid is circulated via the hose through the thermal blankets. The temperature of the fluid is controlled by the main unit and can be either hot or cold.
* ThermaZone® provides thermal therapy with pads specific to various joints as well as different areas of the head (front, sides, back, eyes).
Summary of Evidence
For individuals who have pain and/or swelling after knee surgery who receive a cooling device, the evidence includes systematic reviews, several randomized controlled trials, and a casecontrol study. Relevant outcomes are symptoms, functional outcomes, medication use, and resource utilization. Evidence on manually operated passive noncirculating cooling devices is limited by the control condition used in the trials. Studies that used either a no-icing control or infrequent ice applications do not provide sufficient evidence of comparative efficacy. Other studies have provided no information on the frequency of ice changes, limiting interpretation of the results. Several randomized trials have compared active circulating cooling devices with standard intermittent icing or cold packs, and two of the larger trials found no significant benefit of the continuous cooling devices. The evidence is insufficient to determine the effects of the technology on health outcomes.
For individuals who have pain and/or swelling after shoulder surgery who receive a cooling device, the evidence includes a randomized controlled trial. Relevant outcomes include symptoms, functional outcomes, medication use, and resource utilization. Evidence found that use of compressive cryotherapy produced no significant reduction in pain or medication use compared with the standard ice wrap. The evidence is insufficient to determine the effects of the technology on health outcomes.
For individuals who have pain and/or swelling after facial surgery who receive a cooling device, the evidence includes several small randomized controlled trials and a pilot study. Relevant outcomes include symptoms, functional outcomes, medication use, and resource utilization. There have been mixed results regarding the intervention’s efficacy in reducing neurologic problems as well as improving eye motility, diplopia, mandible functioning, and mouth opening compared with conventional cooling regimens. The evidence is insufficient to determine the effects of the technology on health outcomes.