LCD for Infrared Heating Pad Systems (L12873)

 


 

Contractor Information

Contractor Name 

TriCenturion 

Contractor Number 

77011 

Contractor Type 

DME PSC 

DME MAC/DMERC this DME PSC is affiliated with 

AdminaStar Federal, Inc (Region B), National Heritage Insurance Company (Region A)  

 

LCD Information

LCD ID Number 

L12873 

LCD Title 

Infrared Heating Pad Systems 

Contractor's Determination Number 

INFRED20070701 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

CMS National Coverage Policy 

CMS PUB 100-3, Medicare National Coverage Determinations Manual, Chapter 1, Section 270.6 

Primary Geographic Jurisdiction 

Connecticut
District of Columbia
Delaware
Illinois
Indiana
Kentucky
Massachusetts
Maryland
Maine
Michigan
Minnesota
New Hampshire
New Jersey
New York - Entire State
Ohio
Pennsylvania
Rhode Island
Virginia
Vermont
Wisconsin
West Virginia
 

Oversight Region 

Central Office 

DME Region LCD Covers 

Jurisdiction A/B 

Original Determination Effective Date 

For services performed on or after 10/01/2003  

Original Determination Ending Date 

 

Revision Effective Date 

For services performed on or after 07/01/2007  

Revision Ending Date 

 

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 medical policy, the criteria for “reasonable and necessary” 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 medically necessary.

There are no indications for which these devices have been demonstrated to have any therapeutic effect. The device and any related accessories will be denied as not medically reasonable and necessary. 

Coverage Topic 

Durable Medical Equipment
 

 

Coding Information

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

EQUIPMENT:

E0221

INFRARED HEATING PAD SYSTEM

ACCESSORIES:

A4639

REPLACEMENT PAD FOR INFRARED HEATING PAD SYSTEM, EACH

 

ICD-9 Codes that Support Medical Necessity 

None

 

 

Diagnoses that Support Medical Necessity 

None 

ICD-9 Codes that DO NOT Support Medical Necessity 

All

 

 

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

 

Diagnoses that DO NOT Support Medical Necessity 

All 

 

General Information

Documentation 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 

09/06/2002 

End Date of Comment Period 

10/25/2002 

Start Date of Notice Period 

06/01/2003 

Revision History Number 

INFRED002

Revision History Explanation 

Revision Effective Date: 07/01/2007
INDICATIONS AND LIMITATIONS OF COVERAGE:
Removed DMERC references
DOCUMENTATION REQUIREMENTS:
Removed DMERC references
SOURCES OF INFORMATION:
Information in this section was removed.

03/01/2006 - In accordance with Section 911 of the Medicare Modernization Act of 2003, this policy was transitioned to DME PSC TriCenturion (77011) from DMERC Tricenturion (77011).

Revision effective date: 07/01/2004
LMRP converted into LCD and Policy Article

Last Reviewed On Date 

04/30/2004 

Related Documents 

Article(s)
A19812 - Infrared Heating Pad Systems – Policy Article – Effective July, 2004

LCD Attachments 

There are no attachments for this LCD

 

 

 

Article for Infrared Heating Pad Systems – Policy Article – Effective July, 2004 (A19812)

 

Contractor Information

Contractor Name, Number, and Type 

DME PSC: TriCenturion (77011)
DME MAC: AdminaStar Federal, Inc (17003) , National Heritage Insurance Company (16003)  

 

Article Information

Article ID Number 

A19812 

Article Type 

Article

Key Article 

Yes

Article Title 

Infrared Heating Pad Systems – Policy Article – Effective July, 2004 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

Primary Geographic Jurisdiction 

Connecticut
District of Columbia
Delaware
Illinois
Indiana
Kentucky
Massachusetts
Maryland
Maine
Michigan
Minnesota
New Hampshire
New Jersey
New York - Entire State
Ohio
Pennsylvania
Rhode Island
Virginia
Vermont
Wisconsin
West Virginia

DME Region Article Covers 

Jurisdiction A/B 

Original Article Effective Date 

06/01/2004

Article Revision Effective Date 

03/01/2006

Article Text 

CODING GUIDELINES

An infrared heating pad system (E0221) consists of a pad or pads containing mechanisms (for example, luminous gallium aluminum arsinide diodes) that generate infrared (or near infrared) light and a power source. Replacement pads are coded A4639.

Suppliers should contact the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) for guidance on the correct coding of this item.

Coverage Topic 

Durable Medical Equipment

 

 

Other Information

Revision History Explanation 

03/01/2006 - In accordance with Section 911 of the Medicare Modernization Act of 2003, this article was transitioned to DME PSC TriCenturion (77011) from DMERC Tricenturion (77011)

 

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

Related Documents 

 

LCD(s)
L12873 - Infrared Heating Pad Systems