Notes: Aetna does not cover most therapeutic pillows and cushions because they do not meet Aetna's contractual definition of durable medical equipment (DME) in that they are not durable and because they are not primarily medical in nature and not mainly used in the treatment of disease or injury.
Cushions may be covered if it is an integral part of, or a medically necessary accessory to, covered DME. For example, see CPB 0271 - Wheelchairs and Power Operated Vehicles (Scooters) (wheelchair seat cushions are covered to prevent or treat severe burns or decubiti).
Certain specialized support surfaces may be covered when medically necessary to prevent or treat decubitus ulcers. For medical necessity criteria for specialized cushions to prevent decubiti, see CPB 0430 - Pressure Reducing Support Surfaces.
Aetna considers the MedCline Positioning Device experimental and investigational for gastroesophageal reflux disease and other indications.
The following are some types of pillows and cushions that are not covered by Aetna:
A number or specialized pillows and cushions have been used for cushioning and positioning in the treatment of decubiti, burns, musculoskeletal injuries and other medical conditions. Aetna does not generally cover pillows and cushions, regardless of medical necessity, because they do not meet Aetna's definition of covered durable medical equipment, in that pillows and cushions are not made to withstand prolonged use. In addition, most pillows and cushions are not primarily medical in nature, and are normally of use to persons who do not have a disease or injury.
Person, et al. (2013) reported on an industry-sponsored single-institution, randomized controlled trial evaluating a sleep device (SD) to prevent gastroesophageal reflux disease, consisting of a two-piece inclined base and body pillow (Medcline, Amenity Health, Inc., San Diego, CA) that maintains a patient in lateral position while elevating the head and torso. The study involved 20 healthy volunteers, each subject having 4 impedance-pH tests 6 hours in length. After placement of a reflux probe subjects returned home and ate a standardized meal (1350 kcal, 58g fat). Each subject then lay down in one of 4 randomly assigned positions: SD right side down (SD-R), SD left side down (SD-L), standard wedge any position (W), and flat any position (F). A wireless position monitor documented position during each study. Number of reflux episodes (RE) and esophageal acid exposure (EAE) was blindly calculated for 6 hour periods. Position monitor data was used to compare assigned position to actual position. The investigators found significantly less esophageal acid exposure over 6 hrs occurred sleeping SD-L compared to sleeping W (mean 0.46% v. 3.59%, p<.01), SD-R (mean 0.46% v. 4.59%, p<.001), and F (mean 0.46% v. 3.46%, p<.05). Reflux episodes over 6 hrs were significantly less SD-L than SD-R (mean 5.55 vs. 13.23, p<.05). Patients assigned to SD-L on average spent 83% of first 2 hrs and 61% of 6 hrs in assigned position. Those assigned to SD-R spent 72% of first 2 hrs and 53% of 6 hrs in assigned position. Over 6 hrs, patients sleeping on W and F averaged significantly more time supine than R or L p<.05). Limitations of the study include small sample size and use of healthy volunteers rathter than persons with gastroesophageal reflux disease. Additional studies involving larger numbers of patients and longer durations of followup and clinical endopoints are needed, as well as comparisons with positioning using nonmedical pillows and bed elevation.
|CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":|
|HCPCS codes not covered for indications listed in the CPB:|
|MedCline Positioning Device - no specific code:|
|E0190||Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories|
|Other HCPCS codes related to the CPB:|
|A7032||Cushion for use on nasal mask interface|
|A7033||Pillow for use on nasal cannula type interface, replacement only, pair|
|E1701||Replacement cushions for jaw motion rehabilitation system, package of six|
|E2601||General use wheelchair seat cushion, width less than 22 in., any depth|
|E2602||General use wheelchair seat cushion, width 22 in. or greater, any depth|