Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
List also available in PDF format.
See Treatment Guidelines and Resources for additional information.
Coverage decision: not covered for home use
Effective Date: 03/01/2009; Last reviewed and updated: September 2020
Cryotherapy devices with or without compression, such as the Game Ready™ system, are not covered as Durable Medical Equipment.
Cryotherapy such as the use of ice and/or cryotherapy devices, with or without compression, used in a therapy session are not separately payable as they are considered bundled into the payment of other physical medicine services.
The coverage decision applies to cooling (cryotherapy) devices with or without compression, including but not limited to:
- Game Ready™ GRPro
- Game Ready™ Classic System
- Game Ready™ System
- ArticFlow Cold Therapy System
- AutoChill® system
- Cryotherapy Cold Water Therapy System by Artic® Ice
- Iceman Cold Therapy unit
- OPTI-ICE™ Cold Therapy System
- Polar Care Cub
- Polar Care 500, Polar Care 300
- Versa-Cool™ Portable Cold Therapy Unit
- VitalWrap™ System
Cryotherapy devices with or without compression are used to reduce pain and swelling. These devices pump cold water through a sleeve around the affected limb and may provide intermittent compression by inflating and deflating the sleeve. These devices are classified by the Food and Drug Administration as a powered inflatable tube massager and cold water cooling system. L&I does not cover the Game Ready™ system or other similar devices for home use because the current evidence shows little net benefit compared to the standard of care: rest, ice, compression and elevation (RICE). These devices are considered personal appliances and are not authorized as Durable Medical Equipment per WAC 296-20-1102.
Note that these devices are not approved for marketing or use as a pneumatic compression device to treat lymphedema and chronic venous insufficiency or to prevent deep vein thrombosis.
It is not appropriate to bill the department for cryotherapy devices for home use (Durable Medical Equipment).
CPT® code 97010 – cryotherapy with or without compression. As noted above, this modality is considered bundled into the payment of other physical medicine services.
It is not appropriate to bill CPT® code 97016 (vasopneumatic device) for these clinic based services. This CPT® code is only applicable for clinic-based use of vasopneumatic devices classified by the Food and Drug Administration as Cardiovascular Therapeutic Devices, Compressible limb sleeve.