BlueCross BlueShield of Tennessee Medical Policy Manual

Cooling Devices Used in the Outpatient Setting

DESCRIPTION

This policy does not address the use of conventional ice packs. Ice packs and various cooling bandages and wraps are commonly used following surgery or musculoskeletal and soft tissue injury. These types of cooling therapy are accepted and effective tools used to reduce inflammation, pain and swelling.

Cooling devices use chilled water to decrease the local temperature of tissue. There are a variety of cooling devices available, ranging from gravity-fed devices that are manually filled with iced water, to motorized units that both cool and circulate the chilled water. These devices are typically used when ice packs would normally be applied, e.g., after orthopedic surgical procedures.  In addition, a variety of continuous cooling devices are commercially available and can be broadly subdivided into those providing manually operated passive cold therapy and those providing active cold therapy using a mechanical device.

In passive cooling devices, chilled water is circulated by gravity or built-in hand pump.  Examples of this type of device are the CryoCuff®, ArcticFlow Cold and Polar Care® Cub.

In active cooling devices, a motorized pump operated by battery or electricity circulates chilled water.  Examples of this type of device are the AutoChill®, Hot/Ice Thermal Blanket, Game Ready™ Accelerated Recovery System, Iceman Cold Therapy, Nanotherm™, OPTI-ICE™ Cold Therapy System, Polar Care® 500, and Polar Care® 300.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

There is insufficient evidence in published, peer-reviewed scientific literature to conclude that the application of combination active cooling and compression (cryopneumatic) devices in the outpatient setting have clinical benefits over the conventional application of ice packs and bandages.  Well-designed studies are needed to demonstrate that these devices provide additional clinical benefits.

SOURCES

Adie, S., Naylor, J. M., & Harris, I. A. (2010). Cryotherapy after total knee arthroplasty. A systematic review and meta-analysis of randomized controlled trials. The Journal of Arthroplasty, 25 (5), 709-715. (Level 2 evidence)

American Academy of Orthopaedic Surgeons (2015) Surgical management of osteoarthritis of the knee, evidence based clinical practice guideline. Retrieved January 10, 2018 from http://www.aaos.org.

Alfuth, M., Strietzel, M., Vogler, T., Rosenbaum, D., and Liem. D. (2016, July) Cold versus cold compression therapy after shoulder arthroscopy: a prospective randomized clinical trial. Knee Surgery, Sports Traumatology, Arthroscopy, 24(7), 2209-15. Abstract retrieved January 10, 2018 from PubMed database.

BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2017). Cooling devices used in the outpatient setting (1.01.26). Retrieved January 10, 2018 from BlueWeb. (23 articles and/or guidelines reviewed)

Fullam, K., Caulfield, B., Coughlan, G. F., McGroarty, M., & Delahunt, E. (2015). Dynamic postural-stability deficits after cryotherapy to the ankle joint. Journal of Athletic Training, 50 (9), 893-904. (Level 4 evidence)

Su, E. P., Perna, M., Boettner, F., Mayman, D. J., Gerlinger, T., Barsoum, W., et al. (2012). A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery. Journal of Bone & Joint Surgery (British Volume), 94 (11, Suppl A), 153-156. Abstract retrieved January 9, 2017 from PubMed database.

U. S. Food and Drug Administration. (1993, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K925677 (AutoChil®). Retrieved October 12, 2010 from http://www.accessdata.fda.gov.  

U. S. Food and Drug Administration. (2007, June). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K071050 (CoolSystems). Retrieved January 9, 2017 from http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (1996, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K961855 (PolarCare® 500). Retrieved January 9, 2017 from http://www.accessdata.fda.gov.

Winifred S. Hayes, Inc. Health Technology Brief (2013, December, last update search November 2015) Cold compression therapy for orthopedic conditions. Retrieved January 10, 2018 from www.hayesinc.com. 

ORIGINAL EFFECTIVE DATE:  8/11/2007

MOST RECENT REVIEW DATE:  2/8/2018

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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