This document addresses devices utilized for the treatment of pain and swelling after trauma and surgery and for musculoskeletal and other conditions. Included are both passive cold therapy devices and active cold therapy devices, as well as devices that combine compression, vibration or heat therapy in the same device.

Note: This document does not address the use of:

• Whole body or head cooling devices for adult or pediatric individuals with acute neurologic injury or after sudden cardiac death
• Cold therapy for the prevention of hair loss related to chemotherapy
• Use of compression pumps with or without cooling or heating capabilities, for deep vein thrombosis prophylaxis. For more information regarding such devices, please see the following document:
  • CG-DME-46 Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting

Position Statement

Investigational and Not Medically Necessary:

Active or passive cooling devices (with or without pneumatic compression or vibration) are considered investigational and not medically necessary for all uses, including but not limited to recovery after orthopedic surgery or trauma.

Active or passive devices that combine cooling and heating are considered investigational and not medically necessary for all uses.