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Clinical Policy Bulletin:
Fluidized Therapy (Fluidotherapy)
Number: 0450


Policy

Aetna considers fluidized therapy medically necessary for the treatment of acute or subacute traumatic or non-traumatic musculoskeletal disorders of the extremities.

Aetna considers fluidized therapy experimental and investigational for all other indications (e.g., carpal tunnel syndrome) because of insufficient evidence in the peer-reviewed literature for indications other than the ones listed above.

Notes: Fluidized therapy is considered to be a physical therapy modality subject to the physical therapy guidelines and any applicable plan benefit limits for physical therapy.

Aetna will cover only the professional charges of a physical therapist or other recognized, licensed providers for fluidized therapy and other physical therapy modalities that require direct, one-on-one, patient contact.  Please check benefit plan descriptions.

See also CPB 0174 - Pool Therapy, Aquatic Therapy or Hydrotherapy and CPB 0325 - Physical Therapy Services.



Background

Fluidized therapy (Fluidotherapy®) is a high-intensity heat modality consisting of a dry whirlpool of finely divided solid particles suspended in a heated air stream, the mixture having the properties of a liquid.  Studies comparing its effective heating with that of a paraffin bath and whirlpool have found them to be similar.  The indications for fluidized therapy are similar to paraffin baths and whirlpool.  Use of fluidized therapy dry heat is an acceptable alternative to other heat therapy modalities in reducing pain, edema, and muscle spasm from acute or subacute traumatic or non-traumatic musculoskeletal disorders of the extremities.  Fluidized therapy is contraindicated in patients with local sensory loss or open lesions.

The Work Loss Data Institute's clinical practice guideline on "carpal tunnel syndrome (acute & chronic)" (2011) listed fluidotherapy as one of the interventions/procedures that were considered, but are not currently recommended.

 
CPT Codes / HCPCS Codes / ICD-9 Codes
There is no specific code for fluidized therapy (fluidotherapy):
Other CPT codes related to the CPB:
97036
97113
ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):
354.0 Carpal tunnel syndrome
Other ICD-9 codes related to the CPB:
710.0 - 739.9 Diseases of the musculoskeletal system and connective tissue
800.00 - 959.9 Injury


The above policy is based on the following references:
  1. U.S. Department of Health and Human Services, Center for Medicare & Medicaid Services (CMS). Fluidized therapy dry heat for certain musculoskeletal disorders. Medicare Coverage Issues Manual Section 35-56. Baltimore, MD: CMS; 2002.
  2. Ganz SB, Harris LL. General overview of rehabilitation of the rheumatoid patient. Rheum Dis North Am. 1998;24(1):181-201.
  3. Herrick RT, Herrick S. Fluidotherapy. Clinical applications and techniques. Ala Med. 1992;61(12):20-25.
  4. Borrell RM, Parker R, Henley EJ, et al. Comparison of in vivo temperatures produced by hydrotherapy, paraffin wax treatment, and Fluidotherapy. Phys Ther. 1980;60(10):1273-1276.
  5. Borrell RM, Henley EJ, Ho P, et al. Fluidotherapy: Evaluation of a new heat modality. Arch Phys Med Rehab. 1977;58(2):69-71.
  6. Gloth JM, Matesi AM. Physical therapy and exercise in pain management. Clin Geriatr Med. 2001;17(3):525-535, vii.
  7. Klein MJ. Superficial heat and cold. eMedicine Physical Medicine and Rehabilitation Topic 201. Omaha, NE: eMedicine.com; updated December 16, 2004. Available at: http://www.emedicine.com/pmr/topic201.htm. Accessed July 10, 2005.
  8. Dorf E, Blue C, Smith BP, Koman LA. Therapy after injury to the hand. J Am Acad Orthop Surg. 2010;18(8):464-473.
  9. Work Loss Data Institute. Carpal tunnel syndrome (acute & chronic). Encinitas (CA): Work Loss Data Institute; 2011. Available at: http://www.guideline.gov/content.aspx?id=33178&search=Fluidotherapy. Accessed april 24, 2012.


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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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