CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Dry Hydrotherapy (Hydromassage/Aquamassage) — Coverage Criteria

Policy governing coverage and medical necessity of dry hydrotherapy (hydromassage/aquamassage) devices used to provide massage-like therapy while the patient remains clothed; applies to commercial benefit plans administered by Blue Cross Blue Shield - Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyDry Hydrotherapy (Hydromassage/Aquamassage) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionWhen billing for dry hydrotherapy services, submit claims using unlisted modality code 97039 and specify type and time if constant attendance.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Class IFDA device classification

97039Claims code

Not medically necessaryCoverage stance

NonePrior authorization

Coverage Criteria

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Not Medically Necessary

Not Medically Necessary for chronic conditions — coverage stance and reasoning

Not Medically Necessary: Use of hydrotherapy massagers for the treatment of chronic conditions is considered not medically necessary because the available evidence is insufficient to determine the effects of the technology on health outcomes.

Rationale / Evidence Statement: There is inadequate and insufficient clinical evidence showing that hydrotherapy massagers improve health outcomes for chronic conditions. Studies to date do not provide robust, consistent evidence of benefit for chronic pain or other chronic indications. Given the lack of high-quality evidence demonstrating improvement in patient-centered outcomes, hydrotherapy massagers for chronic conditions are deemed not medically necessary.

This policy aligns the coverage stance with the current evidence base, which does not support routine coverage for hydrotherapy massagers in the management of chronic conditions.

Provider Actions & Billing Guidance

Prior Authorization

No prior authorization is required for dry hydrotherapy services under this policy.

Step Therapy

There are no step therapy requirements specified for dry hydrotherapy services.

Billing Rule

Claim Filing / Billing Instructions

Bill using unlisted modality code 97039 (Unlisted modality). When filing claims with 97039, specify the type of modality, total treatment time, and whether constant attendance was provided as part of the claim documentation.

Use CPT/HCPCS code: 97039
Include modality description (e.g., dry hydrotherapy / hydromassage)
Report total time and indicate constant attendance if applicable

Denial Risk

Denial Risk for Chronic Conditions

Claims for treatment of chronic conditions with hydrotherapy massagers are considered not medically necessary and will be denied.

Denial applies when hydrotherapy is billed for chronic pain or other chronic conditions

Background

Background: Dry hydrotherapy devices—marketed as hydromassage or aquamassage massagers—provide a massage-like experience by circulating heated, pressurized water within a self-contained unit while the individual remains clothed. These commercial products are intended to deliver therapeutic massage without immersion; however, for chronic conditions the clinical evidence supporting health outcome improvements is inadequate.

Definitions

Dry hydrotherapy / hydromassage / aquamassage — definition

Modality namesDry hydrotherapy (also called hydromassage or aquamassage)

Device typeSelf-contained electrically powered device (e.g., bed or chair) with interior rotating/pulsating jets beneath a waterproof barrier

Patient condition during treatmentIndividual remains clothed and sits or lies on top of a waterproof barrier

MechanismCirculates heated, pressurized water streams within the device to deliver massage-like effects (radiant heat + mechanical massage)

Purported benefitsPain alleviation, increased circulation, improved range of motion, relaxation, reduced need for other interventions

Regulatory classFDA Class I therapeutic massager (Product Code ISA; Sec. 890.5660); distinct from immersion hydrotherapy or powered sitz baths