Coverage Policy Manual
Policy #: 2022035
Category: Medicine
Initiated: December 2022
Last Review: August 2023
  Dry Hydrotherapy for Chronic Pain Conditions

Description:
Dry hydrotherapy, also known as hydromassage or aquamassage, is a massage treatment modality that circulates streams of 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, deep relaxation, and reduction of stress and anxiety. Use of dry hydrotherapy has also been suggested to reduce the need for other interventions, by combining the effects of traditional wet hydrotherapy, massage therapy, acupressure, heat therapy, soft tissue manipulation, and trigger point therapy without the need for additional health staff.
 
Specific physiological effects claimed on the Sidmar manufacturer site for its hydromassage tables include purported physiological effects stemming from application of radiant heat and massage (Sidmar, 2022). Purported physiologic effects of radiant heat include analgesic, antispasmodic, decongestive, sedative, and vasodilatory properties, leading to reduced pain, increased relaxation, enhanced capillary blood flow, decreased spasticity, tenderness, and spasm, and increased rates of healing. Purported benefits of massage include increased local blood supply, increased lymphatic drainage and reduction of swelling, muscle relaxation, prevention of adhesions and fibrosis, decreased tendency toward muscle atrophy, and pain reduction and increased ease of mobility.
 
Regulatory Status
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.) (Hydromassage, 2022), Massage Time Pro S10 or ComfortWave S10 branded hydromassage tables (Sidmar Manufacturing Inc.) and SolaJetĀ® Dry-Hydrotherapy Systems (Sidmar, 2022; SolaJet, 2022).
 
Coding
There is no specific CPT code for dry hydrotherapy massage. Dry hydrotherapy massage may be billed with the following unspecified CPT code:
 
CPT 97039 Unlisted modality (specify type and time if constant attendance)

Policy/
Coverage:
Effective December 2022
 
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
 
The use of dry hydrotherapy massagers for the treatment of chronic pain conditions does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness.
 
For members with contracts without primary coverage criteria, the use of dry hydrotherapy massagers for the treatment of chronic pain conditions is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.

Rationale:
New policy created in August 2022 with a search of literature performed through May 20, 2022.
 
There are no peer-reviewed studies on the use of dry hydrotherapy in individuals with chronic pain conditions identified.
 
Health Technology Assessments
 
In 1998, the Washington State Department of Labor & Industries released a technology assessment on the AquaMED dry hydrotherapy unit distributed by JTL Enterprises (Washington State Department of Labor & Industries, 2022). Reviewers did not identify any peer-reviewed publications and summarized limited data reported on the original AquaMED website, including partial excerpts from a masters thesis from the University of West Florida psychology department, measurements from paraspinal scans from 10 patients before and after treatment, conclusions of ultrasound imaging of 20 patients before and after treatment, and results of thermographic imaging on 4 patients before and after therapy. The reviewers also noted that they could not identify any published research that supports claims that dry hydrotherapy can take the place of multiple modalities (eg, heat packs, wet hydrotherapy, massage and/or soft tissue manipulation) or that it provides any durable benefits.
 
Notably, JTL Enterprises, the parent company of both AquaMED and HydroMassage dry hydrotherapy units, announced a brand integration to market both devices under the HydroMassage brand in 2009 (Chiropractic Economics, 2022). In January 2020, the HydroMassage website listed a disclaimer stating that "all benefits of HydroMassage are temporary and apply only to the areas massaged. HydroMassage does not claim to cure or heal any conditions (Hydromassage, 2022)." Manufacturer-provided clinical data previously shared on the AquaMED website is no longer available.
 
To summarize, no published, peer-reviewed literature was identified evaluating the use of dry hydrotherapy in individuals with chronic pain conditions. A technology assessment for the AquaMED device released from the Washington State Department of Labor & Industries in 1998 concluded that it could not identify any published research that supports claims that dry hydrotherapy can take the place of multiple modalities or that it provides any durable health benefits. Well-conducted studies comparing dry hydrotherapy to established interventions for chronic pain conditions are required to evaluate health outcomes.
 
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 (NICE, 2022). 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.
 
2023 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2023. No new literature was identified that would prompt a change in the coverage statement.

CPT/HCPCS:
97039Unlisted modality (specify type and time if constant attendance)

References: Chiropractic Economics.(2009) AquaMED and HydroMassage announce brand integration. January 28, 2009; https://www.chiroeco.com/aquamed-and-hydromassage-announce-brand-integration/. Accessed May 20, 2022.

HydroMassage.(2022) Featured Products. 2022; https://www.hydromassage.com/products/. Accessed May 20, 2022.

HydroMassage.(2022) HydroMassage Benefits: Ways Water Massage Can Improve Wellness & Recovery. January 20, 2022; https://www.hydromassage.com/blog/hydromassage-benefits-for-wellness-recovery/. Accessed May 19, 2022.

National Institute for Health and Care Excellence (NICE).(2017) NICE guideline [NG65]. Spondyloarthritis in over 16s: diagnosis and management. February 28, 2017; https://www.nice.org.uk/guidance/ng65. Accessed May 20, 2022.

Sidmar.(2022) Healthcare Data. 2022; https://sidmar.com/healthcare/healthcare-data/. Accessed May 20, 2022.

Sidmar.(2022) Shop. 2022; https://sidmar.com/shop/. Accessed May 19, 2022.

SolaJet.(2021) The SolaJet. 2021; https://www.solajet.com/products. Accessed May 20, 2022.

Washington State Department of Labor & Industries.(1998) AquaMED Technology Assessment. 1998; https://www.lni.wa.gov/patient-care/treating-patients/treatment-guidelines-and-resources/_docs/AquaMedTA.pdf. Accessed May 20, 2022.


Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
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