Aetna · Identified Aug 14, 2026Medium impact
Cryoanalgesia and Therapeutic Cold (CPB 0297, reviewed 2026-04-14)
Aetna considers passive cold compression therapy units (such as the Aircast Cryo/Cuff, Polar Care Cub and Polar Care Packs) medically necessary DME to control swelling, edema, hematoma, hemarthrosis and pain, and considers passive hot and cold therapy medically necessary. Cryoanalgesia is considered medically necessary for temporary relief of pain due to chronic refractory trigeminal neuralgia when the selection criteria are met, and for pre-operative, intra-operative and post-operative cryoanalgesia for post-operative pain management related to the Nuss or Ravitch procedure. Active cold units with mechanical pumps, devices that deliver both hot and cold therapy, cryoneurolysis for abdominal pain associated with pancreatic cancer, acute pain, cervicogenic headache, occipital neuralgia, peripheral neuropathic pain, phantom limb pain and post-herpetic neuralgia, pre-operative cryoneurolysis for pain following total knee arthroplasty, prophylactic hypothermia for traumatic brain injury, therapeutic hypothermia for cardiogenic shock or hemorrhagic stroke, intra-brain hypothermia for concussion, submucosal cryolysis, the Cooral intraoral cooling system, and bedside percutaneous cryoneurolysis for acute rib fracture pain are considered experimental, investigational or unproven. Passive cold compression therapy units for all other indications, and intra-operative and post-operative cryoanalgesia for post-thoracotomy pain, post-tonsillectomy pain, post-sternotomy pain and post-mastectomy pain, are also considered experimental, investigational or unproven.