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

Please see: Cryotherapy devices with or without compression