Effective Date
June 1, 2013
Revision Date:
January 25, 2024
Bạn đang xem: Hot or Cold Pack Therapy
Policy Last Review Date:
January 25, 2024
Bạn đang xem: Hot or Cold Pack Therapy
Purpose
To provide guidelines for the reimbursement of CPT 97010 “application of a modality to one or more areas; hot or cold packs.” This policy applies to professional providers.
Scope
All products are included, except
- Products where Horizon BCBSNJ is secondary to Medicare (e.g. Medigap).
- COB
- ITS Host MA Non-PPO
- ITS Host MA PPO Non-par
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All Insured and Administrative Services Only (ASO) accounts are included.
Application of a modality to one or more areas; hot or cold packs: Service that does not require the provider to have one-to-one patient contact. The application of this modality is considered to be an integral part of a service or visit by CMS. Therefore the service for the application of hot or cold packs (97010) is a status B (bundled) code on the Medicare Fee Schedule Data Base (MFSDB). Separate payment is not allowed for this service.
97010: Application to 1 or more areas for, but not limited to, hot or cold packs.
Policy:
Horizon BCBSNJ shall consider CPT 97010 for Hot and Cold Packs not separately reimbursable. This denial shall hold the member harmless from being directly billed by the participating providers for the denied charge. Non- participating providers can bill members up to the charge.
The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until such time as the Policy is reviewed and updated to reflect the new or amended coding.
Procedure:
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Deny the application of hot or cold packs procedure code as incidental when performed by an eligible provider in conjunction with physical or medical services, in accordance with CCI edits and Horizon BCBSNJ’s code edit rules or when billed separately. Do not consider payment override modifiers when appended for the purpose of indicating and seeking separate reimbursement for the hot or cold pack.
In denied instances where the provider is participating, there shall be no member liability.
In denied instances where the provider is non-participating, the member’s liability shall be up to the provider’s charge.
Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:
- The terms and conditions of the applicable health benefit plan
- The medical necessity of the services provided
- The members’ eligibility at the time services are rendered.
- The applicable Provider Participation Agreement
- Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
Mandated or legislative required criteria will always supersede.
History
03/26/2013: Policy approved 05/27/2014: Annual Review; Updated formatting per template 06/10/2015: Removed statement from Policy section: “unless the member has been informed that the service is not reimbursable and agrees to assume responsibility for payment”Added statement in policy section on CPT Code & Nomenclature revisions by AMA and under Procedure section what occurs in denied instances; Updated approvers listing. 07/26/2016: Removed reference to CMS LCD ID L27513 because this LCD was retired on 9/30/2015. 08/25/2016: Updated scope 01/25/2024: Added Policy Last Review Date. Updated Limitations and Exclusions with new language provided by Legal.
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