BlueCross and BlueShield of Montana Medical Policy/Codes
Traction Devices For Use In The Home
Chapter: Durable Medical Equipment
Current Effective Date: October 25, 2013
Original Effective Date: July 18, 2013
Publish Date: October 25, 2013
Revised Dates:
Description

Traction is the application of a mild stretch to muscles, ligaments, and tissue to provide relief of pain resulting from a variety of conditions, such as muscle spasm, nerve root compression, osteoarthritis, degenerative joint disease, and others. Traction is frequently used to treat the spine, most often either the cervical or the lumbar spine. When used on the spine, traction promotes separation of the intervertebral joint spaces to reduce impingement of structures in the area. The goal of traction is usually short term pain relief, returning the patient to normal range of motion, and return to work.

Although traction can be accomplished in a variety of ways, home traction is commonly achieved using a system of pulleys, weights, and counterweights connected to a stand (either freestanding or attached to the bed) or “over-the-door” equipment, and connected to a harness or belt worn by the patient.

Policy

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply.  If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coverage

Traction devices for use in the home are considered experimental, investigational, and unproven for the treatment of cervical neck pain and/or lumbar back pain.

Rationale

Although traction has been a commonly used treatment modality and numerous studies have been conducted, there has been little scientific evidence of the effectiveness of traction for cervical neck and/or lumbar back pain. Harte et al. (1) conducted a computer-aided search for randomized controlled trials (RTCs) from 1966 through 2001 to assess the efficacy of traction for treatment of low back pain; the evidence for use of traction in low back pain was inconclusive, and they stated that further trials are needed before firm conclusions and recommendations can be made. Smith, et al., (2) performed a literature review and concluded that no evidence was found for use of traction. Beursken et al. (3) conducted a RTC of 151 patients in which high-dose traction was compared to sham traction, and concluded that traction was not promising for any group and that the data do not support the claim that traction is effective for treatment of low back pain. Reust et al. (4) performed a double-blind RTC of 60 patients and concluded there was no significant difference between the treatment groups (placebo traction, light traction, normal traction). In a criteria-based appraisal of review articles, Hoving et al. (5) found the evidence inconclusive for traction for neck pain and also stated more research is necessary to formulate stronger conclusions. A systematic literature analysis conducted by van der Heijden et al. (6) to assess the efficacy of traction for patients with neck or back pain included RTCs comparing traction with other treatments. They found that no conclusions can be drawn about whether a specific traction modality for back or neck pain is effective, or more efficacious than other modalities, and further that there were no clear indications that traction is an effective therapy.  They also concluded that more trials are needed, with close attention to proper design and methodology.

A MedLINE review of literature through March 2007 did not reveal any new studies that would change the above conclusions. Therefore, traction in the home setting for treatment of cervical neck pain and/or lumbar spine pain is not supported by evidence in the peer-reviewed medical literature that

  • permits conclusions on the effect on health outcomes; and/or
  • demonstrates an improvement in net health outcome.

2013 Update

In a 2008 Cochrane Review to assess the effects of mechanical traction for neck disorders, Graham et al. (7) concluded that the current literature does not support or refute the efficacy or effectiveness of continuous or intermittent traction for pain reduction, improved function or global perceived effect when compared to placebo traction, tablet or heat or other conservative treatments in patients with chronic neck disorders. Large, well conducted RCTs are needed to first determine the efficacy of traction, then the effectiveness, for individuals with neck disorders with radicular symptoms.

In a 2007 Cochrane Review to determine traction's effectiveness, compared to reference treatments, placebo, sham traction or no treatment for low back pain, Clarke et al. (8) concluded that continuous or intermittent traction as a single treatment for low back pain is not likely effective, and that traction for patients with sciatica cannot be judged effective at present either, due to inconsistent results or methodological problems in most studies.

A search of peer reviewed literature through July 2013 identified no new clinical trial publications or any additional information that would change the coverage position of this medical policy.

Coding

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps. 

ICD-9 Codes

721.0, 721.1, 721.3, 721.42, 721.90, 721.91, 722.0-722.2, 722.4-722.93, 723.0-723.2, 723.8, 723.9, 724.00, 724.02, 724.2-724.6, 724.8-724.9, V53.7

ICD-10 Codes

M47, M48, Z46.89

Procedural Codes: E0840, E0849, E0850, E0855, E0860, E0890, E0900, E0920, E0930, E0941, E0942, E0944, E0946, E0947, E0948
References
  1. Harte, A.A., Baxter, G.D., et al. The efficacy of traction for back pain: a systematic review of randomized controlled trials. Archives of Physical Medicine and Rehabilitation (2003 Oct) 84(10):1542-53.
  2. Smith, D., McMurray, N., et al. Early intervention for acute back pain: can we finally develop an evidence-based approach? Clinical Rehabilitation (2002 Feb) 16(1):1-11.
  3. Beurskens, A.J., de Vet, H.C., et al. Efficacy of traction for non-specific low back pain: a randomized clinical trial. Lancet (1995 Dec 16) 346(8990):1596-600.
  4. Reust, P., Chantraine, A., et al. Treatment of lumbar sciatica with or without neurological deficit using mechanical traction. A double-blind study.  Schweizerische Medizinische Wochenschrift (1988 Feb 27) 118(8):271-4.
  5. Hoving, J.L., Gross, A.R., et al. A critical appraisal of review articles on the effectiveness of conservative treatment for neck pain. Spine (2001 Jan 15) 26(2):196-205.
  6. Van der Heijden, G.J., Assendelft, W.J., et al. The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods. Physical Therapy (1995 Feb) 75(2):93-104.
  7. Graham N, Gross A, et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006408. doi:10.1002/14651858.CD006408.pub2.
  8. Clarke JA, van Tulder MW, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD003010.
  9. Kjellman, G.V., Skargren, E.I., et al. A critical analysis of randomized clinical trials on neck pain and treatment efficacy. A review of the literature. Scandinavian Journal of Rehabilitation Medicine (1999 Sep) 31(3):139-52.
  10. Swezey, R.L., Swezey, A.M., et al. Efficacy of home cervical traction therapy.  American Journal of Physical Medicine and Rehabilitation (1999 Jan-Feb) 78(1):30-2.
  11. Gross, A.R., Aker, P.D., et al. Physical medicine modalities for mechanical neck disorders. Cochrane Database Systematic Review (2000) (2):CD000961.
  12. van Tulder, M.W., Koes, B.W., et al. Chronic low back pain: exercise therapy, multidisciplinary programs, NSAID’s, back schools, and behavioral therapy effective; traction not effective; results of systematic reviews.  Nederlands Tijdschrift Voor Geneeskunds (2000 Jul 29) 144(31):1489-94.
  13. Philadelphia panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology. Physical Therapy (2001 Oct) 81(10):1629-40.
  14. Borman, P., Keskin, D., et al. The efficacy of lumbar traction in the management of patients with low back pain. Rheumatology International (2003 Mar) 23(2):82-6.
  15. Clarke, J., van Tulder, M., et al. Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane collaboration. Spine (2006 June 15) 31(14):1591-9.
History
April 2013 New 2013 BCBSMT medical policy.  considered investigational. 
October 2013 Literature reviewed. Coverage unchanged.  Removed HCPCs codes E0830 and E0856.
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Traction Devices For Use In The Home