CurrentBaylor Scott & White Health PlanPolicy 035

Cold Therapy Devices

Defines Baylor Scott & White Health Plan coverage stance on cold (cryotherapy) devices for therapeutic use and outlines applicability across lines of business, Medicare, and Medicaid guidance.

Policy Summary

PayerBaylor Scott & White Health Plan

PolicyCold Therapy Devices

Policy CodePolicy 035

Change TypeNo material change

Effective Date02/01/2026

Next Review Date01/22/2027

Key ActionVerify the member's Evidence of Coverage (EOC) or Summary Plan Description (SPD) for benefit specifics; medical necessity per this policy does not guarantee benefit coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1HCPCS not covered

2026-02-01Effective

01/22/2026Last review

035Policy

Coverage Criteria

General coverage stance

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Stance: Cryogenic machines and water-circulating cold therapy devices (including insulated blankets, circulating pads, and cryopneumatic devices) are considered not medically necessary because they have not been proven more efficacious than traditional cold therapy and are items of convenience.

Policy favors simple cold packs which are not DME and are available OTC.

Cold therapy may be delivered by a range of methods, including cryogenic machines, water-circulating cold pads (e.g., Polar Care and similar systems), simple cold packs (ice, gel, chemical), or vaso-pneumatic cryotherapy devices (e.g., Game Ready) which combine active compression and cold. The policy clarifies that circulating or cryogenic systems (those with reservoirs and pumps or that attach to insulated blankets) are considered alternative delivery methods and have not demonstrated superior clinical benefit compared with traditional passive cold therapy.

Because these circulating systems and cryogenic machines are primarily used for convenience rather than demonstrated improved outcomes, the policy considers them not medically necessary; by contrast, passive cold packs remain an OTC option and are not classified as DME.

Provider Actions & Billing Notes

Note

Prior Authorization / Benefit Verification

Prior authorization is not required for cold therapy devices. Providers should verify member benefits by reviewing the member's Evidence of Coverage (EOC) or Summary Plan Description (SPD); medical necessity determinations under this policy do not guarantee benefit coverage under the member's plan.

Prior Authorization: Not applicable
Action: Verify member EOC/SPD for benefit coverage
Note: Medical necessity does not ensure benefit coverage

Note

Documentation Required

Plan Benefit Verification Required

Providers must review the member's plan EOC/SPD to confirm coverage limits and exclusions. A determination that a device is medically necessary per this policy does not guarantee that the member's benefit plan covers the item or service.

Verify member-specific benefits and coverage rules in the EOC/SPD
Medical necessity under this policy does not equal coverage

Denial Risk

Not Medically Necessary Devices

The following devices and delivery methods are considered NOT medically necessary: cryogenic machines, insulated blankets, water-circulating cold pads (e.g., Polar Care), simple cold packs (ice, gel, chemical), and vaso-pneumatic cryotherapy systems (e.g., Game Ready). These are considered items of convenience and not more efficacious than traditional cold therapy.

Examples: Polar Care, Game Ready, insulated blankets, circulating pads, cryogenic machines, ice/gel/chemical cold packs

Denial Risk

Code-level Denial Risk

HCPCS code E0218 may not be covered; billing under this code carries a denial risk. Inclusion of a code in policy materials does not guarantee reimbursement — confirm benefit and medical necessity prior to billing.

HCPCS: E0218 — potential non-covered code / denial risk

Definitions

Definitions — Cold therapy devices / cryogenic machines

TermCold therapy devices / cryogenic machines

DefinitionDevices that deliver cold therapy, including insulated disposable blankets attached to a cryogenic machine, water‑circulating cold pads (motorized pump circulating cooled water), and cryopneumatic devices with reservoirs and circulation pumps; contrasted with passive cold packs (ice, gel, chemical).

ExamplesInsulated disposable blankets connected to a machine, water‑circulating cold pads (e.g., Polar Care–style systems), cryopneumatic/vaso‑pneumatic cryotherapy systems (e.g., Game Ready).

Mechanism distinctionNon‑circulating devices move water by gravity or hand pump; circulating devices use a motorized pump to circulate cold water to a cuff or wrap.

Policy note on equivalenceClinical trials have not demonstrated superior benefits of circulating or cryogenic devices compared with simple passive cold compresses; circulating systems are primarily items of convenience.

Medical Necessity

Device necessity

Primary criterion: Device must provide clear clinical benefit over standard passive cold therapy to be considered medically necessary; clinical evidence has not demonstrated superior outcomes for circulating or cryogenic devices.

As a result, these devices are considered items of convenience and not medically necessary.

Rental & Purchase Rules

Item	Rule / Guidance
Cold packs
Not DME; can be purchased over the counter without a prescription. Policy favors simple passive cold packs as clinical trials have not demonstrated superior benefits for circulating or cryogenic devices and the same outcomes can be achieved with OTC cold packs.
Rental/purchase specifics
Water-circulating cold pads, cryogenic machines, and similar circulating systems are considered items of convenience and are not supported as DME; policy indicates these are primarily used for patient convenience while passive cold packs are OTC.

Background

Cryotherapy (cold therapy) is applied to promote vasoconstriction, reduce edema and inflammation, and provide pain relief. It is commonly used in post-operative care, at home after injury or exercise, and in rehabilitation or athletic settings.

Clinical trials have not demonstrated superior health benefits for circulating or cryogenic devices compared with simple cold compresses; therefore, while the physiologic rationale for cold therapy is well established, the policy emphasizes that more complex circulating or cryogenic systems have not been shown to improve outcomes beyond what is achieved with standard passive cold therapy.

Not Covered

Not covered: cryogenic machines, water-circulating cold pads (including Polar Care and similar products), and vaso-pneumatic cryotherapy devices (for example, Game Ready). These systems are considered items of convenience because they have not been shown to provide superior clinical outcomes compared with traditional passive cold therapy and therefore are not medically necessary under this policy.