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.
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.
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.
CPT Codes / HCPCS Codes / ICD-9 Codes
HCPCS codes not covered for indications listed in the CPB:
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories
Other HCPCS codes related to the CPB:
Cushion for use on nasal mask interface
Pillow for use on nasal cannula type interface, replacement only, pair
Replacement cushions for jaw motion rehabilitation system, package of six
General use wheelchair seat cushion, width less than 22 in., any depth
General use wheelchair seat cushion, width 22 in. or greater, any depth
The above policy is based on the following references:
Able Medical Aids. Cushions & pillows. Home Medical Supplies and Equipment. Largo, FL: Able Medical Aids; 2005. Available at: http://www.ablemedical.com/. Accessed July 21, 2005.
Therapeutic Pillow International. Contour pillows, back supports & memory foam [website]. Brighton, VIC; Therapeutic Pillow; 2005. Available at: http://www.the-pillow.com.au/. Accessed July 21, 2005.
PillowMart.com. Orthopedic and Therapeutic Pillows [website]. Wichita, KS: PillowMart.com; 2005. Available at: http://www.pillowmart.com/. Accessed July 21, 2005.
Shields N, Capper J, Polak T, Taylor N. Are cervical pillows effective in reducing neck pain? N Z J Physiother. 2006;34(1):3-9.
Craig WR, Hanlon-Dearman A, Sinclair C, et al. Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years. Cochrane Database Syst Rev. 2010;(5):CD003502.
Pennick VE, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2007;(2):CD001139.
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.