BlueCross BlueShield of Tennessee Medical Policy Manual

Cervical Traction Devices for Home Use

DESCRIPTION

Cervical traction is noninvasive traction, used to stretch the soft tissues of the neck and to separate the spinal joint structures in order to relieve neck pain.

A variety of cervical traction devices are available for use in the home:

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Traction devices are classified as Class I devices by the U.S. Food and Drug Administration (FDA). 510(k) clearance is not required, although registration with FDA is required. The FDA has described orthopedic devices as follows: “A non-powered orthopedic traction apparatus is a device that consists of a rigid frame with non-powered traction accessories, such as cords, pulleys, or weights, and that is intended to apply a therapeutic pulling force to the skeletal system.”

According to Centers for Medicare & Medicaid Services (CMS), the 2009 Local Coverage for Determination (LCD) for CIGNA Government Services, it states that “Cervical traction applied via attachment to a headboard or a free-standing frame has no proven clinical advantage compared to cervical traction applied via an over-the-door mechanism.”

The lack of randomized controlled studies and the poor quality of published articles provide little evidence of the efficacy for the use of ambulatory cervical traction, inflatable cervical traction collars, or pneumatic cervical traction devices. In addition, there is a lack of documentation in published articles for specific duration and frequency of these devices that would aid in net health outcomes.  

SOURCES

American College of Occupational and Environmental Medicine. (2011). Cervical and thoracic spine disorders. Retrieved November 8, 2012 from http://www.guideline.gov/content.aspx?id=35207&search=cervical+traction.

Borman, P., Keskin, D., Ekici, B., & Bodur, H. (2008). The efficacy of intermittent cervical traction in patients with chronic neck pain. Clinical Rheumatology, 27 (10), 1249-1253. (Level 3 Evidence - Independent study)

Cai, C., Ming, G., and Ng, L. (2010). Development of a clinical prediction rule to identify patients with neck pain who are likely to benefit from home-based mechanical cervical traction. European Spine Journal, 2011 (20), 912-922. (Level 4 Evidence - Independent study)

Complete Guide to Medicare Coverage Issues [Computer software]. (2012, July). Durable medical equipment (NCD 280.1, 2-252-2-2257. Ingenix.

Graham, N., Gross, A. R., Goldsmith, C., & the Cervical Overview Group. (2006). Mechanical traction for mechanical neck disorders: A systemic review. Journal of Rehabilitation Medicine, 38 (3), 145-152. (Level 1 Evidence – Independent study)

North American Spine Society. (2010). Diagnosis and treatment of cervical radiculopathy from degenerative disorders. Retrieved November 8, 2012 from http://www.guideline.gov/content.aspx?id=23938&search=cervical+traction.

Polston, D. W. (2007). Cervical radiculopathy. Neurologic Clinics, 25 (2), 373-385.

Raney, N. H., Petersen, E. J., Smith, T. A., Cowan, J. E., Rendeiro, D. G., Deyle, G. D., et al. (2009). Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. European Spine Journal, 18 (3), 382-391.

U. S. Department of Health & Human Services. Centers for Medicare & Medicaid Services. LCDs for CGS Adminstrators, LLC. (2011, August). LCD for cervical traction devices (L15905). Retrieved November 7, 2012 from http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=15905&ContrId=140&ver=36&ContrVer=2&articleId=18074&CntrctrSelected=140*2&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=Tennessee&KeyWord=cervical%2btraction&KeyWordLookUp=Title&KeyWordSearchType=And&lcd_id=15905&lcd_version=32&show=all&kq=895472770&ua=highwire&IsPopup=y&#0.

U. S. Food and Drug Administration. (2010, April). Center for Devices and Radiological Health. Code of Federal Regulations. Title 21, Volume 8. Section 888.5850. Nonpowered orthopedic traction apparatus and accessories. Retrieved January 25, 2011 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRsearch.cfm?FR=888.5850.

U. S. Food and Drug Administration. (2011). Center for Devices and Radiological Health. Establishment registration & device listing. 1721293. Retrieved December 30, 2010 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/rl.cfm?lid=174094&lpcd=HST.

Washington State of Labor and Industries. (2002, August). Technology Assessment. Pronex and HomeTrac cervical traction. Retrieved December 30, 2010 from http://www.lni.wa.gov/ClaimsIns/Files/OMD/PronexAndSaundersTA.pdf.

Young, I. A., Michener, L. A., Cleland, J. A., Aguilera, A. J., & A. R. Snyder. (2009). Manual therapy, exercise, and traction for patients with cervical radiculopathy: A randomized clinical trial. Physical Therapy, 89 (7), 632-642. (Level 2 Evidence - Industry sponsored)

ORIGINAL EFFECTIVE DATE:  6/11/2011

MOST RECENT REVIEW DATE:  12/13/2012  

ID_BT

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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