Does E0221 require prior authorization?

No, E0221 does not require prior authorization (high confidence). Covered without prior authorization.

`E0221`, Infrared heating pad system

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted.
For DMEPOS base items requiring Written Order Prior to Delivery (WOPD), the supplier must have received a signed SWO (WOPD) before delivering the item to the beneficiary.
When a WOPD is required for a base item that may have separately billed accessories, the WOPD must list the base item and may list the associated separately billed options/accessories/supplies prior to delivery.
Suppliers are required to maintain proof of delivery (POD) documentation in their files and make POD available to the Medicare contractor upon request.

There are no covered indications for infrared therapy devices; CMS NCD 270.6 found no therapeutic effect and the device and related accessories are denied as not medically reasonable and necessary.
Aetna considers passive hot plus cold therapy medically necessary for indications outlined in CPB 0297 - Cryoanalgesia and Therapeutic Cold.
Aetna considers electric heating pads medically necessary durable medical equipment (DME) to relieve certain types of pain, decrease joint and soft tissue stiffness, relax muscles, or reduce inflammation.
Aetna considers portable paraffin baths medically necessary DME for members who have undergone a successful trial period of paraffin therapy and the member's condition (e.g., severe rheumatoid arthritis of the hands) is expected to be relieved by the long-term use of this modality.
General indications for therapeutic heat include pain, muscle spasm, contracture, tension myalgia, hematoma resolution, bursitis, tenosynovitis, fibrositis, fibromyalgia, superficial thrombophlebitis, and collagen vascular diseases.
Paraffin baths are primarily used to treat contractures, particularly for patients with rheumatoid arthritis, hand contractures, or scleroderma.

L33825, Infrared Heating Pad Systems

AETNA-CPB-0540, Heating Devices

AETNA-CPB-0604, Infrared Therapy

AETNA-CPB-0729, Diabetic Neuropathy: Selected Treatments

BCBSIL-DME101.045, Infrared Therapy Devices

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