CurrentPriority HealthPolicy BILLING POLICY No. 109

CERVICAL TRACTION DEVICES

Policy covers billing, coding, documentation, and coverage considerations for cervical traction devices (HCPCS E0849, E0849, E0855, E0856, E0860) for Priority Health commercial, Medicare (follow CMS unless specified), and Medicaid (follow MDHHS unless specified) products. It addresses applicable modifiers, documentation requirements, place of service, and reimbursement source guidance.

Policy Summary

PayerPriority Health

PolicyCERVICAL TRACTION DEVICES

Policy CodePolicy BILLING POLICY No. 109

Change TypeNo material changes

Effective DateJuly 11, 2025

Next Review Date

Key ActionProviders must meet CMS standard documentation requirements for supplies and DME and follow Pre-Service Organization Determination (PSOD) procedures for Medicare indications that do not meet NCD/LCD or specific medical policy criteria.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5HCPCS codes referenced

3Lines of business applicable

CMS/MDHHSMedicare/Medicaid governance

Policy Scope & Summary

This policy addresses billing, coding, documentation, and coverage considerations for cervical traction devices (HCPCS codes E0849, E0855, E0856, E0860) across Priority Health lines of business: Commercial, Medicare (follows CMS unless specified), and Medicaid (follows MDHHS unless specified). It specifies applicable modifiers and warns that incorrect modifier application may lead to denials, aligns with CMS National Correct Coding Initiative guidance, and directs providers to follow CMS standard documentation requirements (CMS Article A55426) and the Priority Health Provider Manual for place-of-service and authorization rules. Authorization may be required but does not guarantee payment; claims must meet coding and documentation requirements to be paid.

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Clinical and Administrative Background

Cervical traction devices gently stretch the neck to relieve pain and reduce pressure on the cervical spine. The policy describes device variations and key features: E0855 (mandibular or occipital pressure; no door or frame required), E0856 (uses inflatable bladder(s); may or may not use a frame), E0860 (door-mounted, uses pulleys and ropes; for upright or supine use), and E0849 (free-standing frame using pneumatic displacement; >20 lbs force; allows angled traction). For Medicare, when care does not meet NCD, LCD, or medical policy criteria, a Pre-Service Organization Determination (PSOD) is required per the Provider Manual.

Definitions

Cervical traction devicesDevices that gently stretch the neck to relieve pain and reduce pressure on the cervical spine.

PSODPre-Service Organization Determination — required for Medicare when NCD/LCD or medical policy criteria are not met.

HCPCS Codes Referenced

Cervical traction HCPCS codes referencedHCPCS

E0849	Free-standing frame cervical traction; uses pneumatic displacement (not mandibular); >20 lbs force; allows angled traction (e.g., lateral flexion)
E0855	Cervical traction without door/external frame; uses mandibular or occipital pressure; no door or frame required
E0856	Cervical traction with inflatable bladder(s); may or may not use a frame; uses inflatable bladders for traction
E0860	Door-mounted cervical traction; uses pulleys and ropes; attaches to a door; upright or supine use
E0849	Free-standing frame cervical traction (duplicate listing in source document)

Documentation, Authorization & Billing Requirements

Documentation Required

CMS standard documentation required

Providers must meet CMS standard documentation requirements for supplies and DME; reference CMS Article A55426 - Standard Documentation Requirements for All Claims Submitted to DME MACs for required documentation elements for claims submitted to DME MACs.

CMS Article A55426 - Standard Documentation Requirements for All Claims Submitted to DME MACs

Prior Authorization

Medicare PSOD requirement when NCD/LCD criteria not met

For Medicare indications that do not meet the criteria of an NCD, local LCD, or specific medical policy, a Pre-Service Organization Determination (PSOD) must be completed per Provider Manual guidance.

PSOD (Pre-Service Organization Determination) — see Provider Manual

Billing Rule

Modifier application and denials

Priority Health follows CMS NCCI and requires appropriate HCPCS modifiers; incorrect application of modifiers will result in denials.

KX — indicates policy criteria has been met for wheelchair DME items; claims reported without KX will deny as non-payable (Commercial, Medicaid products).
GA — per CMS local coverage determinations for claim processing of wheelchair DME items.
GY — per CMS local coverage determinations for claim processing of wheelchair DME items.
GZ — per CMS local coverage determinations for claim processing of wheelchair DME items.

Billing Rule

Place of service and authorization

Coverage will be considered when furnished in an appropriate setting to the patient's medical needs and condition; authorization may be required. Providers should consult the Provider Manual and the Durable Medical Equipment place of service billing policy for specific POS billing requirements.

See Provider Manual for PSOD and authorization guidance
See Durable Medical Equipment (DME) place of services (POS) billing policy for POS-specific billing rules

Documentation Required

Authorization is not a guarantee of payment

An authorization does not override coding, billing, or reimbursement requirements; proper documentation and coding must be present or claims may be denied, recouped, or rejected.

An authorization on file does not supersede coding, billing or reimbursement requirements; failure to document or follow coding requirements may result in claim denial or recovery.

Policy Summary

PayerPriority Health

PolicyCERVICAL TRACTION DEVICES

Policy CodePolicy BILLING POLICY No. 109

Change TypeNo material changes

Effective DateJuly 11, 2025

Next Review Date

SourceLink

On This Page

CERVICAL TRACTION DEVICES

Policy Scope & Summary

Clinical and Administrative Background

HCPCS Codes Referenced

Documentation, Authorization & Billing Requirements

Related Policies & Reference Materials