Latest Review Date: November 2024

Category: Therapy                                                 

POLICY:

The use of dry hydrotherapy massagers for the treatment of chronic pain conditions is considered investigational.

DESCRIPTION OF PROCEDURE OR SERVICE:

Dry hydrotherapy, also known as hydromassage or aquamassage, is a massage treatment modality that circulates heated, pressurized water in a self-contained device such as a bed or chair. The individual remains clothed and dry as they sit or lie on top of a waterproof barrier containing rotating and pulsating interior jets. Purported benefits of dry hydrotherapy include alleviation of pain, increased blood circulation, improved range of motion, and decreased need for other interventions.

KEY POINTS:

This most recent literature update was performed through October 28, 2024.

Summary of Evidence

For individuals with chronic pain conditions (e.g., musculoskeletal, neuropathic, and mixed pain conditions) who receive dry hydrotherapy, there are no published, peer-reviewed studies. Relevant outcomes are symptoms, functional outcomes, quality of life, medication use, and resource utilization. A health technology assessment released in 1998 for the AquaMED device also failed to identify published research to support claims that dry hydrotherapy can take the place of multiple modalities or that it provides any durable health benefits. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

Practice Guidelines and Position Statements

National Institute for Health and Care Excellence

In 2017, the National Institute for Health and Care Excellence (NICE) published a guidance on the diagnosis and management of spondyloarthritis in individuals over 16 years of age. The guidance recommends consideration of hydrotherapy as an adjunctive therapy to manage pain or improve function for individuals with axial spondyloarthritis. However, it is unclear whether this recommendation applies to the use of dry hydrotherapy.

KEY WORDS:

AquaMED, dry hydrotherapy, hydroMassage, aquamassage, wet hydrotherapy, SolaJet, Massage Time Pro S10, ComfortWave S10

APPROVED BY GOVERNING BODIES:

Dry hydrotherapy devices are classified by the U.S. Food and Drug Administration (FDA) as class I therapeutic massagers, which are defined as electrically powered devices intended for medical purposes, such as to relieve minor muscle aches and pains. Class I devices are exempt from 510(k) requirements and do not require submission of clinical data regarding efficacy but only notification of FDA prior to marketing (FDA Product Code: ISA; Sec. 890.5660).

Dry hydrotherapy does not involve water immersion and should not be confused with immersion hydromassage baths or powered sitz baths (FDA Product Code: ILJ; Sec. 890.5100).

Examples of currently marketed dry hydrotherapy devices include but may not be limited to HydroMassage branded (previously AquaMED) beds and loungers (JTL Enterprises Inc.), Pro S10 or ComfortWave S10 branded hydromassage tables (Sidmar Manufacturing Inc.), and SolaJet® Dry-Hydrotherapy Systems.

BENEFIT APPLICATION:

Coverage is subject to member’s specific benefits.  Group-specific policy will supersede this policy when applicable.

ITS: Home Policy provisions apply

FEP contracts: Special benefit consideration may apply.  Refer to member’s benefit plan.  

CURRENT CODING:

CPT Codes:

REFERENCES:

1. Chiropractic Economics. AquaMED and HydroMassage announce brand integration. January 28, 2009; www.chiroeco.com/aquamed-and-hydromassage-announce-brand-integration/.
2. HydroMassage. HydroMassage Benefits: Ways Water Massage Can Improve Wellness & Recovery. January 20, 2022; www.hydromassage.com/blog/hydromassage-benefits-for-wellness-recovery/.
3. IOM (Institute of Medicine). 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press.
4. National Institute for Health and Care Excellence (NICE). NICE guideline [NG65]. Spondyloarthritis in over 16s: diagnosis and management. February 28, 2017; www.nice.org.uk/guidance/ng65.
5. Sidmar. Healthcare Data. 2022; https://sidmar.com/healthcare/healthcare-data/. HydroMassage. Featured Products. 2022; www.hydromassage.com/products/.
6. Sidmar. Shop. 2022; sidmar.com/shop/.
7. SolaJet. The SolaJet. 2021; www.solajet.com/products.
8. Washington State Department of Labor & Industries. AquaMED Technology Assessment. 1998; www.lni.wa.gov/patient-care/treating-patients/treatment-guidelines-and-resources/_docs/AquaMedTA.pdf.

POLICY HISTORY:

Medical Policy Group, June 2022 (7): New Policy. This technology was previously investigational for dates of service prior to July 2022 per policies #629-  Medical Criteria for Osteopathic/Chiropractic Manipulative Treatment Policy and #132-Rehabilitative/Habilitative Medical Criteria for Physical/Occupational Therapy Policy. No change to coverage stance. Available for comment July 1, 2022 through August 15, 2022.

Medical Policy Administrative Committee: June 2022

Medical Policy Panel, November 2023

Medical Policy Group, December 2023 (7): Minor update to Key Points, Benefit Application, and References. No change in Policy Statement.

Medical Policy Panel, November 2024

Medical Policy Group, November 2024 (7): Minor updates to Key Points and Approved by Governing Bodies. No change in Policy Statement.

This medical policy is not an authorization, certification, explanation of benefits, or a contract. Eligibility and benefits are determined on a case-by-case basis according to the terms of the member’s plan in effect as of the date services are rendered. All medical policies are based on (i) research of current medical literature and (ii) review of common medical practices in the treatment and diagnosis of disease as of the date hereof. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels of care and treatment.

This policy is intended to be used for adjudication of claims (including pre-admission certification, pre-determinations, and pre-procedure review) in Blue Cross and Blue Shield’s administration of plan contracts.

The plan does not approve or deny procedures, services, testing, or equipment for our members. Our decisions concern coverage only. The decision of whether or not to have a certain test, treatment or procedure is one made between the physician and his/her patient. The plan administers benefits based on the member’s contract and corporate medical policies. Physicians should always exercise their best medical judgment in providing the care they feel is most appropriate for their patients. Needed care should not be delayed or refused because of a coverage determination.

As a general rule, benefits are payable under health plans only in cases of medical necessity and only if services or supplies are not investigational, provided the customer group contracts have such coverage.

The following Association Technology Evaluation Criteria must be met for a service/supply to be considered for coverage:

1. The technology must have final approval from the appropriate government regulatory bodies;
2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes;
3. The technology must improve the net health outcome;
4. The technology must be as beneficial as any established alternatives;
5. The improvement must be attainable outside the investigational setting.

Medical Necessity means that health care services (e.g., procedures, treatments, supplies, devices, equipment, facilities or drugs) that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease or its symptoms, and that are:

1. In accordance with generally accepted standards of medical practice; and
2. Clinically appropriate in terms of type, frequency, extent, site and duration and considered effective for the patient’s illness, injury or disease; and
3. Not primarily for the convenience of the patient, physician or other health care provider; and
4. Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.