Does E0235 require prior authorization?

No, E0235 does not require prior authorization (high confidence). Covered without prior authorization.

`E0235`, Paraffin bath unit, portable (see medical supply code a4265 for paraffin)

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

For portable paraffin baths: documentation of a successful trial period of paraffin therapy and documentation that the member's condition is expected to be relieved by long-term use of the modality (e.g., severe rheumatoid arthritis of the hands).
Requests for multiple heating devices must be supported (they are subject to medical review).
Device/product specifications required: The heating pad must be certified by Underwriters Laboratories.
Standard electric heating pad requirements: must have a fabric cover and a timing device for automatic shut-off; if heat-retaining material is included it must be contained in an enclosed pouch or bag in or around the heating elements.

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.
Hot packs (hydrocollator packs) are used to heat the body part prior to physical therapy (general therapeutic heat application).

AETNA-CPB-0540, Heating Devices

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Ask Backwork about documentation requirements, denial risks, or coverage in your state.