Pillows and Cushions (DME coverage)
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Defines Aetna's coverage stance for pillows and cushions as durable medical equipment (DME), describing types not covered, limited situations where cushions may be covered as part of or accessory to covered DME, and designation of a specific device (MedCline) as experimental/investigational.
No material clinical or coverage changes in this revision.
Coverage criteria for pillows and cushions (DME)
General Coverage and Exclusions
Not covered except in specific circumstances
Examples listed in policy include backrest/lumbar cushions, cervical pillows, custom-molded cushions, heat & massage foam cushion pads, massage pillows, positioning pillows, sleeping pillows, specialized pillows for disabled children, standard allergy-free pillows, and traction pillows.
Study cited in policy has limitations; device is not covered for these indications.
The policy lists specific pillow and cushion types that are not covered. Examples include cervical pillows (cervical pillow rolls, neck cushions), custom-molded cushions, heat and massage foam cushion pads, massage pillows, positioning pillows (e.g., bed wedges, knee elevators, leg spacers, posture wedges), sleeping pillows (ergonomic/orthopedic pillows and foam wedges), specialized pillows for disabled children, standard allergy-free pillows, and traction pillows (e.g., Dutchman's roll, flexion pillow, pelvic sacral blocks, sternal roll).
Backrest and lumbar support items are also listed as not covered, including lumbar cushions, lumbar pads and lumbar rolls (examples cited in the policy include multiple commercial backrest cushions).
Aetna considers most pillows and cushions not medically necessary as DME because they generally do not meet the contractual definition of durable medical equipment: they are typically not sufficiently durable for prolonged use and are not primarily medical in nature or mainly used in the treatment of disease or injury.
An exception exists when a cushion is an integral part of, or a medically necessary accessory to, covered DME (for example, wheelchair seat cushions used to prevent or treat severe burns or decubiti), in which case coverage follows the medical necessity criteria for the underlying covered DME.
When cushions are considered medically necessary
When cushions are covered
Covered only when integral to or a medically necessary accessory to covered DME
Refer to related policies (CPB 0271 - Wheelchairs and Power Operated Vehicles and CPB 0430 - Pressure Reducing Support Surfaces) for specific medical necessity criteria for specialized cushions to prevent or treat decubiti.
Referenced HCPCS codes
| E0190 | Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories. |
| A7032 | Cushion for use on nasal mask interface. |
| A7033 | Pillow for use on nasal cannula type interface, replacement only, pair. |
| E1701 | Replacement cushions for jaw motion rehabilitation system, package of six. |
| E2601 | General use wheelchair seat cushion, width less than 22 in., any depth. |
| E2602 | General use wheelchair seat cushion, width 22 in. or greater, any depth. |
Provider actions, billing guidance, and denial risks
HCPCS codes and prior authorization
HCPCS codes referenced for cushions and pillows: E0190, A7032, A7033, E1701, E2601, E2602. Prior authorization and medical necessity determinations must follow the payer's DME coding and medical necessity rules for these HCPCS codes.
- E0190 — Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories.
- A7032 — Cushion for use on nasal mask interface.
- A7033 — Pillow for use on nasal cannula type interface, replacement only, pair.
- E1701 — Replacement cushions for jaw motion rehabilitation system, package of six.
- E2601 — General use wheelchair seat cushion, width less than 22 in., any depth.
- E2602 — General use wheelchair seat cushion, width 22 in. or greater, any depth.
Provider billing and coding actions
When billing or submitting claims, follow standard DME billing rules and ensure the item is coded to the HCPCS code that matches the device. The policy does not specify separate rental vs purchase rules for these codes; follow payer DME billing policies.
Documentation to support medical necessity
Document clinical justification that the cushion is either integral to covered DME or a medically necessary accessory to covered DME (for example, a wheelchair seat cushion used to prevent or treat severe burns or decubiti). Include the specific medical condition being prevented or treated and reference related coverage (e.g., wheelchair or pressure-reducing support surface policies) when applicable.
- State that the cushion is an integral part of covered DME or a medically necessary accessory to covered DME.
- Describe the specific clinical indication (e.g., prevention or treatment of severe burns or decubiti) and link to CPB 0271 or CPB 0430 criteria if relevant.
Claims denial risks for therapeutic pillows and cushions
Claims for most therapeutic pillows and cushions will be denied because they do not meet Aetna's DME definition — they are not durable and are not primarily medical in nature or mainly used in treatment of disease or injury. Expect denials for listed noncovered items (e.g., backrest/lumbar cushions, cervical pillows, custom-molded cushions, positioning/sleeping pillows, massage pads, traction pillows) and for the MedCline device as experimental/investigational.
- Therapeutic pillows and cushions are generally not covered as DME because they are not durable and not primarily medical in nature.
- MedCline Positioning Device is considered experimental and investigational and is not covered.
- Examples of noncovered items include backrest/lumbar cushions, cervical pillows, custom-molded cushions, heat & massage foam cushion pads, positioning pillows, sleeping pillows, specialized pediatric pillows, standard allergy-free pillows, and traction pillows.
Items and devices not covered
Not covered items specified in the policy include: backrest/lumbar cushions (lumbar cushions, pads, rolls), cervical pillows (neck rolls and inflatable neck rests), custom-molded cushions, heat and massage foam cushion pads, massage pillows, positioning pillows (bed wedges, knee cushions, leg spacers, posture wedge products), sleeping pillows (ergonomic and orthopedic sleeping pillows and foam wedges), specialized pediatric pillows, standard allergy-free pillows, and traction pillows.
The policy specifically lists numerous commercial examples for several categories (e.g., Accu-Back, Niagara Massage Pillow, Mediflow Waterbase Pillow) to illustrate the types of products that are excluded from coverage.
The MedCline Positioning Device (a two-piece inclined base and body pillow intended to maintain lateral position while elevating head and torso) is designated by Aetna as experimental and investigational for gastroesophageal reflux disease and other indications and is therefore not covered.
The policy notes the evidence includes a small randomized trial with limitations (industry-sponsored, 20 healthy volunteers), supporting the designation of the device as experimental.
Rules for rental and purchase of cushions
| Equipment | HCPCS | Policy note |
|---|---|---|
| Positioning cushion / pillow / wedge | E0190 | HCPCS E0190: positioning cushion/pillow/wedge, any shape or size; policy lists this code but does not specify rental vs purchase rules — follow standard DME billing and medical necessity requirements (covered only when integral to or a medically necessary accessory to covered DME). |
| Cushion for nasal mask interface | A7032 | HCPCS A7032 is listed as related to this policy (cushion for use on nasal mask interface); coverage depends on whether the cushion is an integral part of or a medically necessary accessory to covered DME. |
| Pillow for nasal cannula interface (replacement, pair) | A7033 | HCPCS A7033 is listed as related to this policy (pillow for use on nasal cannula interface, replacement only, pair); follow standard DME medical necessity rules. |
| Replacement cushions (jaw motion rehab system, pkg of 6) | E1701 | HCPCS E1701 is included in the code list; the policy does not specify replacement intervals for replacement cushions here. |
| General use wheelchair seat cushion, width <22 in. | E2601 | HCPCS E2601: general use wheelchair seat cushion, width less than 22 in.; coverage is neutral in this policy — may be covered when integral to or a medically necessary accessory to covered DME (see wheelchair policy). |
| General use wheelchair seat cushion, width >=22 in. | E2602 | HCPCS E2602: general use wheelchair seat cushion, width 22 in. or greater; policy lists the code and directs standard DME billing and medical necessity evaluation. |
Replacement cushion guidance
Required documentation to support coverage
Documentation must support cushion is integral to or accessory of covered DME
Ensure documentation specifically states how the cushion is integral to, or is a medically necessary accessory of, covered DME (for example, a wheelchair seat cushion used to prevent or treat severe burns or decubiti).
- Document the clinical indication and how the cushion attaches to or is required by the covered DME.
- Reference related policies for specific medical necessity criteria (e.g., wheelchair and pressure-reducing support surface policies).
Background and clinical context
Specialized pillows and cushions have been used clinically for cushioning and positioning in the treatment of decubiti, burns, musculoskeletal injuries and other conditions. These products are intended to offload pressure, position limbs or the torso, and protect vulnerable skin areas during recovery.
Despite these clinical uses, Aetna’s policy states pillows and cushions are generally not covered because they are not made to withstand prolonged use and are not primarily medical in nature; coverage is limited to circumstances where the cushion is integral to or a medically necessary accessory of covered DME (for example, wheelchair seat cushions to prevent or treat severe burns or decubiti).
Device-specific definitions and status
Policy revision history
Policy became effective.
Policy last reviewed on this date; content reaffirmed and administrative review recorded.
Next scheduled policy review date.
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