Article Detail - JD DME

Original Effective Date: 10/01/2000           
Revision Effective Date: 11/01/2013

Medicare coverage policy for standard (non-portable) whirlpool baths (E1310) is limited to those cases where the patient is homebound and it is prescribed for conditions where the whirlpool bath can be expected to provide a substantial therapeutic benefit justifying its cost. Payment for conditions such as bursitis or chronic osteoarthritis would not generally be justified because it would not be expected that a whirlpool bath would be significantly more beneficial than a normal warm bath.

If the patient is not homebound, payment for this item in the patient's home is restricted to the cost of providing the service elsewhere, e.g., an outpatient department of a participating hospital, if that alternative is less costly. Payment is restricted to the cost of the whirlpool bath and does not include remodeling or installation expenses.

Documentation supporting the medical necessity for a standard whirlpool bath should accompany all initial claims. This documentation should include:

• Information concerning the patient's medical condition; and,
• Evidence that a whirlpool bath offers significantly more therapeutic benefit than a normal warm bath; and,
• Verification that the patient is homebound or that payment in the home is the least costly alternative.

Portable whirlpools are not covered. Jacuzzis, hot tubs, spas, and other similar types of non-medical bath equipment are also not covered.