Whirlpools / Hot Tubs - Medical Necessity Criteria
Are whirlpools and hut tubs medically necessary? Will they be covered by insurance?
Contents:
- Will insurance pay for a hot tub or whirlpool?
- Medical necessity criteria for whirlpool as hydrotherapy
- Medical necessity criteria for whirlpool bath equipment
- Documentation to submit
- Health plan criteria for whirlpools / hot tubs and other references
Whirlpools are sometimes used as a hydrotherapy modality, where therapists use agitated water to relieve pain and muscle spasms, cleanse wounds, and/or improve circulation.
Will insurance pay for a hot tub or whirlpool?
Hot tubs and whirlpools are primarily and customarily used for a non-medical purpose and so they are generally not considered medically necessary durable medical equipment. Instead, whirlpools*, hot tubs, heated spas, pools, saunas, Jacuzzi tubs, Hydro-jets, Turbo-jets, and the like are considered personal hygiene / comfort / convenience items — not primarily medical in nature. As such, with a very few narrow exceptions, they are NOT covered by health insurance plans.
* This includes various whirlpool equipment generally used for soothing or comfort purposes, including:
- Aqua-Whirl
- Aquasage Portable Whirlpool
- Hydro Jet Whirlpool Bath
- Jacuzzi Portable Whirlpool Pumps
- Portable Whirlpool Pumps
- Whir-A-Bath
- Whir-o-Matic
Medical necessity criteria for whirlpool as hydrotherapy
As part of physical therapy / rehabilitative services, whirlpool therapy may be considered medically necessary as part of a treatment plan for the following indications:
- Pain relief
- Muscle spasm relief
- Improvement of circulation
- Wound care
Medical necessity criteria for whirlpool bath equipment
Does Medicare cover whirlpools?
Medicare covers whirlpool bath equipment if ALL of the following conditions are met:
- The patient is homebound.
- The patient has a condition for which the whirlpool bath can be expected to provide therapeutic benefits that are substantial enough to justify its cost.
If the patient has a condition as described in no. 2 but he/she is not homebound, Medicare restricts payment to the cost of providing the whirlpool bath service elsewhere (such as in a hospital’s outpatient) if that alternative is less costly.
Documentation to submit
These are the things you can prepare documentation of in order to support your statement that whirlpool therapy / equipment is medically necessary. Submit only those that apply.
Documentation of a condition for which whirlpool hydrotherapy may be considered medically necessary and part of the treatment plan:
Documentation that patient is homebound, if requesting for whirlpool bath equipment to be used at home:
Clinical information about the patient’s health status that supports the assertion that they are homebound:
Health plan criteria for whirlpools / hot tubs and other references
- ActiveHealth Management Guideline on Physical Therapy Services
- Aetna Clinical Policy Bulletin on Bathroom and Toilet Equipment and Supplies
- Aetna Clinical Policy Bulletin on Physical Therapy
- Blue Cross Blue Shield of North Carolina Corporate Medical Policy on Rehabilitative Therapies
- Blue Cross Blue Shield of North Dakota Criteria for Durable Medical Equipment
- Blue Shield of California Medical Policy on Physical Therapy
- Cigna Medical Coverage Policy on Physical Therapy
- Deseret Select Summary Plan Description
- Harvard Pilgrim Health Care Policy on Durable Medical Equipment
- Health Net / Centene Corporation Criteria for Durable Medical Equipment and Orthotics and Prosthetics Guidelines
- Independence Blue Cross / Keystone Health Plan East Benefit Booklet
- Medicare National Coverage Determination for Durable Medical Equipment
- Medicare Benefit Policy Manual on Home Health Services
- Premera Blue Cross Utilization Guideline on Durable Medical Equipment
- Regence BlueCross BlueShield of Utah Medical Benefit Booklet
- Tennessee State Plan Document
- TRICARE Policy on Durable Medical Equipment, Prosthetics, Orthotics and Medical Supplies