CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Dry Hydrotherapy (Hydromassage / Aquamassage) Coverage Criteria

Policy governs coverage stance for dry hydrotherapy devices (self-contained heated pressurized water massage beds/chairs) used to treat chronic pain and related conditions for Blue Cross Blue Shield - Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyDry Hydrotherapy (Hydromassage / Aquamassage) Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 11, 2022

Next Review DateAug 1, 2025

Key ActionVerify member benefits and Evidence of Coverage or Subscriber Agreement; no prior authorization applies under this policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not medically necessaryCommercial coverage stance

Not coveredMedicare Advantage stance

Class IRegulatory classification

97039Claims coding

No prior authAdmin note

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Coverage Determinations

Coverage stance

Coverage determinations

Medicare Advantage: Dry hydrotherapy massagers for treatment of chronic pain conditions are not covered because the evidence is insufficient to determine the effects of the technology on health outcomes.

Medicare Advantage specific statement

Commercial Products: Dry hydrotherapy massagers for treatment of chronic pain conditions are not medically necessary because the evidence is insufficient to determine the effects of the technology on health outcomes.

Commercial product specific statement

Benefit variation note: Benefits may vary between groups/contracts; refer to the Evidence of Coverage or Subscriber Agreement for applicable not medically necessary/not covered benefits.

Administrative note

Benefits for dry hydrotherapy massagers may vary by group or contract. Refer to the member's Evidence of Coverage or Subscriber Agreement to determine whether the service is covered or considered not medically necessary/not covered for that specific plan.

For Commercial Products, the use of dry hydrotherapy massagers for the treatment of chronic pain conditions is not medically necessary because the evidence is insufficient to determine the effects of the technology on health outcomes.

Claims Coding Instructions

Claims coding instructionCPT

97039

Unlisted modality (specify type and time if constant attendance)

Provider Requirements & Billing Guidance

Prior Authorization

Not applicable — no prior authorization is required for this policy. Verify member coverage and benefits prior to rendering services.

Note

Administrative note: This policy has no medical-necessity criteria. Providers should consult the member's Evidence of Coverage or Subscriber Agreement for benefit-specific limitations and exclusions.

Billing Rule

Claims Filing & Benefits Verification

Claims for dry hydrotherapy massagers should be filed using unlisted modality code 97039. When submitting, specify the modality type and include time if constant attendance is provided. Always verify member benefits and coverage rules prior to billing.

Background

Dry hydrotherapy (also called hydromassage or aquamassage) refers to self-contained beds or chairs that circulate heated, pressurized water to deliver pulsating and rotating jets of massage while the individual remains clothed and dry. Claimed benefits include pain relief, improved circulation, increased range of motion, relaxation, and potential reduction in other interventions; however, the current evidence is considered insufficient to establish meaningful health outcome benefits for treatment of chronic pain.

Because coverage varies by contract and the clinical evidence is limited, claims for dry hydrotherapy devices may be treated differently across product lines—verify member benefits and plan documents before billing or scheduling.

Definitions & Regulatory Classification

Definition — dry hydrotherapy

TermDry hydrotherapy (hydromassage / aquamassage)

DefinitionA massage modality using heated, pressurized water circulated inside a self-contained device (bed or chair) where the individual remains clothed and dry on top of a waterproof barrier while receiving pulsating and rotating interior jets.

Also known asHydromassage; Aquamassage

Device configurationSelf-contained bed, lounger, or chair with internal rotating and pulsating jets and a waterproof barrier ensuring the patient remains dry.

Purported benefitsAlleviation of pain, increased blood circulation, improved range of motion, relaxation, and reduced need for other interventions.

Regulatory classification