Heating Pads and Heat Lamps - Policy Article

**NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES**  
  
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. Information provided in this policy article relates
to determinations other than those based on Social Security Act 1862(a)(1)(A)
provisions (i.e. "reasonable and necessary").  
  
Heating pads are covered under the Durable Medical Equipment benefit (Social
Security Act 1861(s)(6)). In order for a beneficiary's equipment to be
eligible for reimbursement the reasonable and necessary (R&N) requirements set
out in the related Local Coverage Determination must be met. In addition,
there are specific statutory payment policy requirements, discussed below,
that also must be met.  
  
A nonelectric heating pad or wrap (A9273) does not meet the definition of
durable medical equipment (DME) and will be denied as noncovered.  
  
Hydrocollator units (E0225, E0239) are considered institutional equipment and
will be denied as statutorily noncovered.  
  
 **REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO Final Rule 1713 (84 Fed.
Reg Vol 217)**  
  
Final Rule 1713 (84 Fed. Reg Vol 217) requires a face-to-face encounter and a
Written Order Prior to Delivery (WOPD) for specified HCPCS codes. CMS and the
DME MACs provide a list of the specified codes, which is periodically updated.
The required Face-to-Face Encounter and Written Order Prior to Delivery List
is available [here](https://www.cms.gov/Research-Statistics-Data-and-
Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-
Review/FacetoFaceEncounterRequirementforCertainDurableMedicalEquipment).  
  
Claims for the specified items subject to Final Rule 1713 (84 Fed. Reg Vol
217) that do not meet the face-to-face encounter and WOPD requirements
specified in the LCD-related Standard Documentation Requirements Article
(A55426) will be denied as not reasonable and necessary.  
  
If a supplier delivers an item prior to receipt of a WOPD, it will be denied
as not reasonable and necessary. If the WOPD is not obtained prior to
delivery, payment will not be made for that item even if a WOPD is
subsequently obtained by the supplier. If a similar item is subsequently
provided by an unrelated supplier who has obtained a WOPD, it will be eligible
for coverage.  
  
**POLICY SPECIFIC DOCUMENTATION REQUIREMENTS**  
  
In addition to policy specific documentation requirements, there are general
documentation requirements that are applicable to all DMEPOS policies. These
general requirements are located in the DOCUMENTATION REQUIREMENTS section of
the LCD.  
  
Refer to the LCD-related Standard Documentation Requirements article, located
at the bottom of this Policy Article under the Related Local Coverage
Documents section for additional information regarding GENERAL DOCUMENTATION
REQUIREMENTS and the POLICY SPECIFIC DOCUMENTATION REQUIREMENTS.  
  
 **CODING GUIDELINES**  
  
A standard electric heating pad (E0210) is a flexible device containing
electric resistive elements producing heat. It must have a fabric cover. It
must have a timing device for automatic shut-off. It may include heat-
retaining material (e.g., gel, fluid, vegetable matter). If so, the heat
retaining materials must be contained in an enclosed pouch or bag in or around
the heating elements. The heating pad must be certified by an Occupational
Safety and Health Administration (OSHA) Nationally Recognized Testing
Laboratory (NRTL) (29 CFR 1910.7). A heating pad that includes a cover or
other element that utilizes water vapor (humidity) drawn from the air to
create moisture when heated is billed using this code.  
  
A moist electric heating pad (E0215) is a flexible device containing electric
resistive elements producing heat. It must have a fabric cover. It must have a
timing device for automatic shut-off. It must have a component that absorbs
and retains liquid water. The water containing element must be protected from
contact with the electrical components and the water must be in direct contact
with the skin on application. The heating pad must be certified by an OSHA
NRTL (29 CFR 1910.7). A cover or other element that utilizes water vapor
(humidity) drawn from the air to create moisture when heated does not meet the
definition of this code. Water must be added to the device to meet the
description of this code.  
  
A water circulating heat pad with pump (E0217) is a flexible pad containing a
series of channels through which water is circulated by means of an electrical
pumping mechanism. The water is heated in an external reservoir. The pump,
pad, and all accessories needed for the pad to be functional are included in
the code. The device must be certified by an OSHA NRTL (29 CFR 1910.7).  
  
A hydrocollator unit (E0225, E0239) is a container which is filled with water
and then heated. Bags of silicone dioxide or other material are placed in the
heated water. These packs/pads are then applied to the body part over towels.
They are used to heat the body part prior to physical therapy.  
  
Code E0249 is a durable replacement pad used with a water circulating heat
pump system (E0217). It is made of rubber, heavy plastic, or durable fabric.
It can be cleaned and is designed for long term use. A replacement pad made of
other material that is designed for shorter term use must be billed using code
A9999 (Miscellaneous DME supply or accessory, not otherwise specified).  
  
Heating pads that do not meet the coding criteria described above for E0210,
E0215 or E0217 must be billed with code E1399.  
  
Suppliers should contact the Pricing, Data Analysis, and Coding (PDAC)
contractor for guidance on the correct coding of these items.