Are Cold Therapy Machines Covered By Insurance? | Get Paid Or Denied

Yes, coverage can happen, but plans often pay only with a prescription, clear post-op need, and the right billing path.

Cold therapy machines (the circulating “ice machine” many surgeons hand out after knee, shoulder, ankle, or hip work) sit in a gray zone with insurers. Some people get part of the cost paid back. Others get a denial that feels random.

The difference is rarely luck. It’s usually the route you take: how the device is labeled (DME vs “convenience”), what your plan says, and whether your paperwork matches what the payer expects.

This article walks you through the coverage reality, the fastest way to check your odds, and the steps that raise your chance of payment without wasting weeks.

What a cold therapy machine is in insurance terms

Most units used at home circulate chilled water through a pad that straps onto your joint. Some add compression. People call them “ice machines,” “cold therapy units,” or brand names like Polar Care or Game Ready.

Insurance rarely cares about brand first. It cares about category and benefit rules. Many payers treat these devices as:

• Durable medical equipment (DME) when billed through an approved supplier with a matching code and a prescription.
• Post-surgical supplies bundled into a facility or surgeon package.
• Not medically necessary when the plan says standard ice packs do the same job.

That last bucket is why denials are common. Multiple payer policies state that active or passive cooling devices don’t show enough added benefit over standard icing for routine outpatient use. One example is Anthem’s medical policy on cooling devices. You can read how they frame this in Anthem’s policy on cooling devices.

Taking a cold therapy machine through insurance rules after surgery

If you want a close-to-real answer fast, start with three questions:

1. Is the device being rented or purchased through a DME supplier that’s in-network? Out-of-network supply routes can trigger automatic denials.
2. Do you have a prescription and a post-op diagnosis that matches the payer’s coverage logic? “Pain” alone can be too broad. Post-op swelling management tied to a procedure is clearer.
3. Is your plan type fully insured, self-funded, Medicare, or Medicaid? The same insurance card brand can behave in different ways based on the plan.

If you can’t get clear answers from the first rep, ask for the “DME benefits team” or “claims review team,” then ask for coverage by code and by supplier name.

When insurance is more likely to cover it

Coverage tends to show up in a few patterns:

• Rental instead of purchase for a short post-op window, billed as DME through an in-network supplier.
• Plan exceptions when there’s a reason standard icing isn’t suitable (skin risk, sensation issues, or a surgeon’s post-op plan tied to your case).
• Out-of-pocket first, then partial reimbursement when you submit a claim with a prescription and an itemized receipt that includes codes.

Even in these situations, it often comes down to documentation and matching your claim to the path your plan already accepts.

Medicare: what the public rules say

Medicare coverage is often quoted in confusing ways because people mix up “cold therapy devices” with other rehab equipment.

For cold therapy devices billed as DME, CMS has a policy article in the Medicare Coverage Database that describes coverage under the DME benefit and ties payment to meeting local coverage and payment rules. You can see this framing in CMS Medicare Coverage Database: Cold Therapy policy article (A52460).

Separate from cold therapy, Medicare also has a public page for continuous passive motion machines used in knee rehab after surgery. That page helps show how Medicare talks about post-op equipment in plain language and what costs can depend on. See Medicare coverage for CPM machines.

Takeaway: Medicare may recognize cold therapy devices under the DME umbrella in policy language, but payment still hinges on local rules and how the claim is billed. That’s why two people can have different results in different regions.

Private insurance: why policies often say “no”

Many commercial plans have written policies that label circulating cooling devices as not medically necessary for routine outpatient use, often citing limited evidence of added benefit versus regular icing.

A clear example is Excellus BlueCross BlueShield’s medical policy, which states that active or passive cold therapy devices are not medically necessary for any indication under their policy framework. You can review that position in Excellus BCBS policy on cryotherapy (cold therapy) devices.

This doesn’t mean every Excellus member will be denied in every situation. It means the default posture is denial unless your plan has a rider, a special benefit, or a claims pathway that treats your device as covered DME.

What “covered” can mean in real dollars

People hear “covered” and think “free.” Insurance language is narrower. Coverage can mean:

• Allowed, then applied to deductible: the claim is accepted but you pay until your deductible is met.
• Allowed with coinsurance: you pay a percentage and the plan pays the rest.
• Allowed only as rental: the plan pays for a short window, then stops.
• Denied, but appealable: the plan rejects it first, but you can ask for a review with more records.

So the best question to ask your insurer is: “Is this item allowed under my DME benefit, and what is my patient responsibility if it is allowed?”

Fast path: the call script that gets usable answers

When you call, don’t ask “Do you cover ice machines?” That phrasing triggers vague replies. Ask tighter questions:

1. “Do I have a DME benefit for home-use devices after surgery?”
2. “If I rent a circulating cold therapy unit through an in-network DME supplier, is it allowed under my plan?”
3. “What documents do you require: prescription, diagnosis, operative note, therapy plan?”
4. “Do you require prior authorization for DME rentals tied to orthopedic surgery?”
5. “If you deny it, what is the appeal window and what address or portal do you require?”

Write down the rep’s name or ID, the call reference number, and the exact wording you’re told. That detail often matters later when a claim is processed by a different team.

Documents that often decide the outcome

Cold therapy claims tend to hinge on whether the file tells a clean story. Aim for a packet that includes:

• Prescription with device type and duration (rental length if rental).
• Diagnosis tied to a procedure (post-op pain and swelling after a named surgery reads clearer than a generic pain code).
• Operative note or discharge instructions that mention icing or cold therapy as part of the plan.
• Itemized receipt showing supplier name, device description, rental dates, and any billing codes listed.
• Letter from surgeon when there’s a special reason a circulating unit is needed for your case.

Keep copies of everything. If you upload files, save screenshots of upload confirmations.

How billing codes can trip people up

Some people try to bill these devices like a simple hot/cold pack treatment used in therapy clinics. That can be a mismatch.

CPT code 97010 is often used for hot or cold pack application in therapy settings, and Medicare commonly treats it as bundled into other therapy services rather than paying it as a standalone line item. If you’re trying to understand how CMS views that code in practice, one plain-language overview is on TheraPlatform’s explanation of CPT 97010 billing basics.

For a home cold therapy machine, your claim may be processed under DME billing logic instead. That’s why asking for the DME pathway, supplier requirements, and any prior authorization is usually more productive than chasing therapy codes.

If your supplier gives you codes, include them on the claim form exactly as provided. If they don’t, ask the supplier for an itemized statement that lists any applicable codes used for billing.

Table 1: Coverage outcomes and what shifts the odds

Coverage path	What payers often look for	What you can do
In-network DME rental	Prescription, post-op diagnosis, allowed DME benefit, rental dates	Use an in-network supplier, ask about prior authorization, submit full packet
In-network DME purchase	Medical review, plan policy on cooling devices, deductible status	Ask if purchase is allowed or rental-only, get written confirmation
Facility bundle	Whether the device is treated as part of surgical supplies	Ask the facility billing office if it’s included in your package
Out-of-network supplier	Network rules, claim form completeness, reimbursement limits	Request a gap exception only if no in-network option exists
HSA/FSA reimbursement	Whether your plan administrator allows the expense with a receipt	Keep receipts and prescription, submit through your HSA/FSA portal
Initial denial, then appeal	Policy language, medical records, timing within appeal window	Appeal with surgeon letter and post-op notes, ask for peer review if offered
Cash pay	No review	Ask supplier for rental pricing, compare to ice packs and compression wraps
Workers’ compensation claim	State rules, injury acceptance, treating provider authorization	Route through your adjuster and treating provider, avoid personal plan billing

Appeals: what to write so the reviewer can say “yes”

If you get a denial, don’t panic. Many denials are template language triggered by a policy that assumes “routine outpatient use.” Your goal is to show why your case isn’t routine or why your plan benefit still allows it.

A clean appeal package usually includes:

• A one-page cover letter stating the denial reason, the service dates, and what you’re asking for (rental or purchase reimbursement).
• Prescription and operative note attached right behind the cover letter.
• Surgeon letter written in plain terms: procedure performed, expected swelling/pain window, why the unit was ordered, and how long it was needed.
• Receipts and supplier details that match the dates in the records.

Keep the cover letter short. The reviewer may have minutes, not hours. Use bullet points. Put dates in bold.

Rental vs purchase: the practical math

Even if your plan allows a device, it may prefer rental. That can work in your favor because many people only use the unit for the first phase after surgery.

Ask the supplier for both numbers. Then compare them to your deductible and coinsurance. If you’re early in the year and your deductible is untouched, “covered” may still mean you’re paying most of it.

If you’re close to your out-of-pocket maximum, a covered rental can land cheaper than a cash purchase. The numbers change by plan, so run the math with your plan’s benefit summary in front of you.

Table 2: Common costs and what changes them

Cost item	Typical range	What shifts the total
Basic circulating cold unit (purchase)	$120–$250	Brand, pad size, single-use vs reusable pads
Cold unit rental (weekly)	$25–$60	Local supplier pricing, rental length, pickup vs delivery
Cold + compression systems (rental)	$90–$250	Clinic contract pricing, compression feature, pad type
Replacement pads	$20–$80	Joint type, proprietary connectors, bundled kits
Shipping or delivery fees	$0–$40	Distance, same-day delivery, return shipping rules
Insurance deductible impact	Plan-dependent	Remaining deductible, DME coinsurance, network status
Out-of-network reimbursement	Often low or none	Plan rules, allowed amount caps, missing documentation

What to do if your surgeon’s office sells the device

Some offices sell or rent units directly. That can be convenient, but it can complicate insurance because the office may not be an approved DME supplier under your plan.

If you want insurance payment, ask two things before you take the unit home:

• “Is this office an in-network DME supplier for my plan?”
• “Will I receive an itemized statement with the supplier details and any codes you use?”

If the answer is no, you may still be able to submit for reimbursement, but many plans will treat it as out-of-network supply or a retail purchase.

Using HSA or FSA funds when insurance says no

If your plan denies the claim or the paperwork route is a headache, check whether your HSA or FSA administrator will reimburse the expense. Many accounts reimburse items tied to a medical expense when you have a receipt and, at times, a prescription. Rules vary by administrator, so follow their portal prompts.

Keep your receipt, the prescription, and a short note with the surgery date. That record can save time if you’re asked to justify the purchase later.

Red flags that commonly lead to denial

• No prescription or prescription doesn’t match the device or dates.
• Out-of-network supplier when in-network options exist.
• Receipt lacks detail (no item description, no dates, no supplier contact info).
• Claim submitted under the wrong benefit path (therapy billing logic used for home DME).
• Plan policy labels the device as not medically necessary and your records don’t explain a case-specific reason.

A simple action list you can run today

1. Ask your surgeon’s office for a prescription that names the device type and expected use window.
2. Call your insurer and ask for DME coverage rules for a home cold therapy unit after your procedure.
3. Pick an in-network DME supplier when possible, then request an itemized quote for rental and purchase.
4. Ask if prior authorization is required. If yes, don’t skip it.
5. Save every document: prescription, operative note, discharge sheet, receipts, and call reference numbers.
6. Submit the claim with a clean packet. If denied, appeal with a short cover letter and a surgeon letter.

Cold therapy machines can be paid by insurance, but the winning route is usually the boring one: in-network supplier, clean paperwork, and the benefit path your plan already uses for DME.