Cigna / ASH Medical Coverage Policies

Cigna / ASH Medical Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document may differ significantly from the standard benefit plans upon which these Cigna / ASH Medical Coverage Policies are based. In the event of a conflict, a customer’s benefit plan document always supersedes the information in the Cigna / ASH Medical Coverage Policy. In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document.

Determinations in each specific instance may require consideration of:

1. the terms of the applicable benefit plan document in effect on the date of service
2. any applicable laws/regulations
3. any relevant collateral source materials including Cigna-ASH Medical Coverage Policies and
4. the specific facts of the particular situation

Where coverage for care or services does not depend on specific circumstances, reimbursement will only be provided if a requested service(s) is submitted in accordance with the relevant guidelines and criteria outlined in this policy, including covered diagnosis and/or procedure code(s) outlined in the Coding Information section of this policy. Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this policy. When billing, providers must use the most appropriate codes as of the effective date of the submission. Claims submitted for services that are not accompanied by covered code(s) under this policy will be denied as not covered.

Cigna / ASH Medical Coverage Policies relate exclusively to the administration of health benefit plans. Cigna / ASH Medical Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. Some information in these Coverage Policies may not apply to all benefit plans administered by Cigna. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make benefit determinations. References to standard benefit plan language and benefit determinations do not apply to those clients.

GUIDELINES

Medically Necessary Strapping is considered medically necessary for the management of immobilization of a joint and restriction of movement with strapping tape (i.e., rigid, non-elastic or non-stretchy tape) for ANY of the following indications:

• strapping of hand or finger (CPT code 29280) for:

• fracture of finger
• dislocation of finger

• strapping/taping of ankle or foot (CPT code 29540) for:

• acute sprains and strains of ankle and foot

Strapping and Taping (CPG 143)

• dislocations of ankle and foot
• fractures of ankle and foot
• tendinitis and synovitis of ankle and foot
• plantar fasciitis
• tarsal tunnel syndrome

• strapping of toes (CPT code 29550) for:

• fracture of toes
• dislocation of toes
• sprains and strains of toes
• hallux valgus
• hammer toe

Strapping for any indication not listed above is not covered or reimbursable.

Not Covered or Reimbursable

Strapping is not covered or reimbursable for the following body parts and for any other indications:

• Shoulder (CPT code 29240)
• Chest or thorax (CPT code 29200)
• Hip (CPT code 29520)
• Elbow or wrist (CPT code 29260)
• Knee (CPT code 29530)
• Back (CPT code: 29799)

Experimental, Investigational, Unproven

Elastic therapeutic taping (i.e., Kinesio taping) or rigid therapeutic taping (i.e., McConnell) is considered experimental, investigational, and/or unproven for ANY indication including but not limited to:

• back pain
• radicular pain syndromes
• other back-related conditions
• lower extremity spasticity
• meralgia paresthetica
• post-operative subacromial decompression
• wrist injury
• performance enhancement
• prevention of ankle sprains

Strapping

Strapping is used when the desired effect is to provide immobilization or restriction of movement. Strapping refers to the application of overlapping strips of tape or adhesive plaster to a body part to exert pressure on it and serve as a splint to hold a structure in place and reduce motion.

There are many types of tape used for strapping purpose, but in general the tape used for strapping is a rigid, non-elastic or non-stretchy tape. In general, strapping may be used to treat strains, sprains, dislocations, and some fractures.

The purpose of strapping is to stabilize or protect a fracture, injury, or dislocation and/or to afford comfort to a patient without a restorative treatment or procedure. Strapping limits ROM and/or restricts muscle movement. Strapping is used for acute injuries or as a result of disease or surgery. The goals and outcomes are stabilization of the injured area, reduced pain, aid recovery, and to provide support so the area heals in the correct position.

Strapping services are usually provided outside a therapy plan of care. At times, the term taping is used interchangeably with strapping. However taping that is not used to provide immobilization or restriction of movement or is used as part of a therapy program is not considered strapping.

If the purpose of the taping is to immobilize a joint, then the strapping codes are appropriate as these codes describe the use of a strap or other reinforced material applied post-fracture (or other injury) to immobilize the joint. Strapping materials are rigid and non-elastic. They are usually highly adhesive. Often pre-wrap is required prior to application. Premade splints are not strapping materials.

Strapping and Taping (CPG 143)

Strapping is not synonymous with therapeutic taping when considering methods such as McConnell taping or elastic therapeutic taping (e.g., Kinesio tape, Spidertech tape). These types of taping are used in conjunction with provision of skilled therapeutic exercises, functional training, gait training, manual therapy, or neuromuscular re-education (NMR) techniques and would be considered part of the exercise or NMR or other procedure.

Indications include orthopedic and neurologic conditions. Proposed benefits include but are not limited to improved feedback and timing of muscle activation, reduced pain, reduced swelling and improved circulation. Strapping can be performed as an initial treatment or as a replacement service during or after follow-up care.

Strapping may also refer to taping for prevention of injury or re-injury to support a joint with ligamentous instability. An adhesive zinc oxide based tape is used that is stiff in nature and not elastic. As an example, the proposed mechanism of strapping/taping of the ankle joint is to limit physiological range of motion (ROM) and control talar tilt.

It is also suggested that adhesive strapping/taping can act as a secondary ligament based on tape alignment and application in a way that prevents extremes of motion. This is also similar to low dye taping for plantar fasciitis. Low dye taping assists the soft tissues in support of the longitudinal arch of the foot to reduce stress on the plantar fascia. The combination of the body tissues and strapping/taping improves the capacity to dissipate the energy associated with potentially traumatic forces. It is also believed that the strapping/taping stimulates the skin receptors which facilitates muscle contraction.

Elastic Therapeutic Taping (e.g., KinesioTM tape, SpidertechTM tape)

Elastic therapeutic tape differs from traditional white athletic tape in the sense that it is elastic and can be stretched to 140% of its original length before being applied to the skin. It is theorized that it provides a constant pulling (shear) force to the skin over which it is applied unlike traditional white athletic tape. The fabric of this specialized tape is air permeable and water resistant and can be worn for repetitive days (Halseth, et al., 2004).

This specialized taping, also referred to as kinesio taping (KT), is utilized as part of a rehabilitation program, and is not used for acute injury or to immobilize a body part. This type of taping is generally provided in therapy by chiropractors, physical therapists and occupational therapists in a therapy program. The application of the tape is included in the time spent in direct contact with the patient to provide either re-education of a muscle and movement, or to stabilize one body area to enable improved strength or range of motion. The application of tape may be performed in combination with education of the patient on various functional movement patterns and with therapeutic exercise, gait training, neurological re-education and manual therapy in the treatment of orthopedic, neuromuscular or neurological conditions.

Generally the tape will be left in place after instruction related to movements. Taping provided during a therapy program should be included in the therapeutic modality that is being provided and should not be billed separately. The tape is available in various lengths or pre-cut. There are several types of elastic therapeutic tape available including:

• KinesioTM tape (Kinesio Taping, LLC. Albuquerque, NM)
• SpiderTechTM tape (SpiderTech Inc., Toronto, Ontario)
• KT TAPE/KT TAPE PROTM (LUMOS INC., Lindon, UT)

Use of elastic therapeutic taping purportedly acts to prolong the benefits of manual therapy administered in the clinical setting. A second technique is used to lift the skin over an area of inflammation, thereby increasing the interstitial space, promoting circulation and lymphatic drainage in an effort to reduce swelling, pressure and pain. It is generally related to the following diagnoses:

• Bruising
• Edema and swelling
• Repetitive strains/sprains
• Pain due to arthritis
• Trauma or chronic pain syndrome
• Rotator cuff injuries
• Plantar fasciitis
• Weakness resulting in postural and biomechanical imbalances
• Restricted range of motion and joints not tracking properly

Strapping and Taping (CPG 143)

The expected benefits of treatment include:

• Improved feedback and timing of muscle activation in controlling joint stability during functional exercises
• Stimulation of optimal muscle activation and strength
• Lessened irritation of subcutaneous neural pain receptors
• Reduced swelling, improved circulation
• Enhanced functional stability and mobility
• Support of weakened and strained muscles

Elastic tape is applied in a specific manner relying on the origin and insertion of the muscle.

Per course education, it can be applied in different directions, and with differing amounts of stretch; which (hypothetically) determines its ability to re-educate the neuromuscular system, reduce inflammation and pain, promote circulation and healing, prevent injury and enhance performance. It should always be used in conjunction with other treatment interventions during the acute rehabilitation and chronic phase of treatment. The wear time is 3-4 days according to KT course education.

As mentioned previously, elastic therapeutic tape is used while providing skilled therapeutic exercises, manual therapy, or NMR techniques in the treatment of sports injuries and a variety of other disorders. Dr. Kenso Kase, a chiropractor, developed Kinesio taping (KT) techniques in the 1970s. It is claimed that elastic therapeutic tape supports injured muscles and joints and helps relieve pain by lifting the skin and allowing improved blood and lymph flow. Opening up this area is also thought to relieve pressure on nerve endings that send pain messages to the brain. Additionally, the tape is thought to stretch the fascial tissue for extended periods of time which is claimed to be beneficial; this is thought to also reduce muscle spasms. Elastic therapeutic tape users also propose that with muscle application, which is common in athletic settings, application of tape for a line of pull from origin to insertion will enhance or facilitate muscle activity, and taping from insertion to origin will inhibit or relax muscle based on Golgi tendon organ (GTO) actions.

From a proprioceptive standpoint, it is theorized that placing it over a tendon or ligament will amplify signals to the brain regarding the amount of tension over that particular area. In this way, it stimulates the GTO and helps the brain perceive and react to the support. Other stated proposed uses of the tape are for functional corrections. The tape would be applied to muscles and joints that are flexed and the tape is then used to 'preload' or assist the joint through its range of motion (ROM). Proponents postulate that in this shortened position more information is passed through the neural network and muscle contractions are supported or assisted. At this time these are all theoretical in nature.

Rigid Therapeutic Taping (i.e. McConnell Taping)

Rigid taping methods to illicit positional changes include McConnell taping, which uses Leukotape applied over Cover-roll tape to change joint mechanics through positional changes of boney and/or soft tissue structures as part of a comprehensive rehabilitation program. Jenny McConnell has pioneered its use.

McConnell taping began with the patellofemoral joint and is now being utilized for other joints in the body, such as the hip and shoulder joints. For the patellofemoral joint, the physical correction of malalignment is just one reason why patella taping is thought to be effective for Patellofemoral Pain Syndrome (PFPS). As the patella is more correctly positioned within the trochlear groove, tracking during flexion and extension of the knee is normalized. Theoretically, with this repositioning, the vastus medialis oblique (VMO) function may also be enhanced. Similar principles exist for the other joints with regard to correcting position of the head of the humerus and scapula. Taping for the hip joint, with its surrounding soft tissue thickness, primarily focuses on muscle length changes. The neuromuscular reeducation CPT code is used with this type of rigid taping.

Additionally, this form of taping is not used for immobilization of joints (e.g., wrist, hand, elbow, ankle, and knee due to severe sprain/strain or in some cases, fracture) and does not use overlapping straps.

The following uses of therapeutic taping are professionally recognized and safe; however, additional studies are needed before the clinical effectiveness can be established. Use of elastic or rigid taping techniques as part of comprehensive treatment program may be clinically appropriate for the following:

• Rigid therapeutic taping for pain reduction in patellofemoral pain syndrome;
• Rigid therapeutic taping of the shoulder in patients with hemiplegia

The use of rigid taping or elastic taping for rehabilitation of orthopedic or neurologic conditions is not intended as a sole treatment or as a separately billable procedure, but rather is part of a broad treatment program that includes exercise, manual therapy and/or neuromuscular re-education (NMR) and is inclusive in these procedures. Strapping codes are not allowed for application of therapeutic taping. Strapping and Taping (CPG 143)

DOCUMENTATION GUIDELINES

that a healthcare “Medically necessary” or “medical necessity” shall mean health care services practitioner/provider, exercising prudent clinical judgment, would provide to a patient for the purpose of evaluating, diagnosing, or treating an illness, injury, disease or its symptoms, and that are (a) in accordance with generally accepted standards of medical practice; (b) clinically appropriate in terms of type, frequency, extent, site, and duration; and considered effective for the patient’s illness, injury, or disease; and (c) not primarily for the convenience of the patient or healthcare provider, and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury, or disease.

The patient’s medical records should document the practitioner’s clinical rationale for performing the specific strapping or taping procedures, as well as, the patient’s response. Any time taping is done; the health care record must clearly document the specific reasons for, and location of, the taping. If the service that includes the taping is billed to a payor, the taping must be consistent with the documented chief complaint / clinical examination findings, diagnosis and treatment plan. The assessment will support the medical necessity and is often established through the history and objective evaluation. After medical necessity is established, a treatment plan with goals and objective measures, including time frames, is documented.

According to the AMA CPT Assistant, if Kinesio taping is performed to facilitate movement by providing support, and the tape is applied specifically to enable less painful use of the joint and greater function, (restricting in some movement, facilitating in others), application of the tape in this manner is typically part of neuromuscular re- education (97112) or therapeutic exercises (97110), depending on the intent and the outcome desired. In these cases, the application of the tape would be included in the time spent in direct contact with the patient and would not be appropriately billed using strapping codes.