Cooling Devices Used in the Home and Outpatient Setting
Customize your policy alerts
Sign up for all Blue Cross Blue Shield - Rhode Island policy alerts
Know when Blue Cross Blue Shield - Rhode Island releases new policies or updates existing guidance.
Monitor payer policy activity
This policy governs coverage for cooling devices (passive and active water-circulating and gravity-fed systems) used in the home and outpatient settings; it affects Medicare (BlueCHiP for Medicare) and commercial members of Blue Cross Blue Shield - Rhode Island.
No material clinical or coverage changes in this revision.
Coverage Criteria
Not covered when used in the home or outpatient setting
Coverage determination summary
Supported by statements in policy
For Commercial products, cooling devices — whether they include a pumping mechanism or not — are classified as convenience items and are not covered. Applicable contract exclusions should be applied when adjudicating claims for these devices.
Under BlueCHiP for Medicare, cooling devices are considered not covered because the device is determined to be not reasonable and necessary for the intended use in the home or outpatient settings.
DMERC guidance is reflected in this policy stance: devices such as a water circulating cold pad with pump (HCPCS E0218) and functionally similar electric circulating systems will be denied as not medically necessary when billed as DME.
Coding
Provider Actions and Billing Guidance
Prior Authorization
Not applicable
Benefit verification and documentation
Benefits may vary by contract. Refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable exclusions and limitations of benefits/coverage and for documentation requirements.
Step Therapy
No step therapy requirements specified in this policy. Benefit design may vary by contract.
Coverage stance leading to denial
BlueCHiP for Medicare: Cooling devices will be considered not covered because the device is not reasonable and necessary. Commercial Products: Cooling devices, with or without pumping action, are considered convenience items and are not covered; contract exclusions apply. Providers should verify member benefits and do not bill members for noncovered services unless the member has been informed and agreed in writing to be financially responsible in advance.
Background
Cooling devices — both passive and active systems — are used to reduce local tissue temperature after surgery or soft‑tissue injury with the intent to decrease inflammation, pain, and swelling. Passive devices rely on gravity or manual pumping to deliver chilled fluid to cuffs or pads, while active systems use a motorized pump that circulates chilled fluid and may provide pneumatic compression. Evidence from randomized trials is mixed and does not consistently demonstrate superior clinical outcomes for continuous or active cooling devices compared with standard intermittent icing regimens.
Definitions
Evidence and Medical Necessity
Evidence and medical necessity
Evidence summary relevant to medical necessity
Policy concludes insufficient evidence to determine effects on health outcomes
Rental and Purchase Rules
| Equipment | Rental/Purchase Rule | Coverage Status |
|---|---|---|
| Gravity-fed ice‑water reservoir devices (manual/passive systems, e.g., CryoCuff, Polar Care Cub) | ||
| Per DMERC guidance, devices in which ice water is placed in a reservoir and circulated by gravity are not considered DME and must be coded as noncovered (A9270) if submitted to the DMERC. | ||
| Not covered | ||
| Electric pump circulating devices (motorized water‑circulating pads) | ||
| DMERC states that water circulating cold pads with electric pumps (HCPCS E0218) are denied as not medically necessary. | ||
| Not covered |
Documentation Requirements
Verify benefits and notify member for noncovered services
Verify member benefits and document that the member was informed if you will bill them for a noncovered service; obtain written member agreement before charging for services that are noncovered or not medically necessary.
- Confirm benefits via Benefit Booklet/Evidence of Coverage and provider call center.
- Document member notification and written agreement if member will be charged for noncovered services.
Not Covered Items
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.