Cervical Traction Documentation Needs
The following qualification criteria need to be documented in the patients’ medical record notes to qualify for the prescribed equipment.  Note: Justification notes are valid for six months.

Over door cervical traction devices: 1 and 2 need to be sufficiently documented to support the need for the prescribed equipment

1. Document the patients musculoskeletal or neurologic impairment requiring traction equipment;

2. Document the appropriate use of a home cervical traction device has been demonstrated to the patient and the beneficiary tolerated the traction device.

Freestanding Cervical traction devices: 1 and 2 above and either criteria A, B or C need to be sufficiently documented to support the need for the prescribed equipment

A. The beneficiary has a diagnosis of temporomandibular joint (TMJ) dysfunction; and has received treatment for the TMJ condition; or,

B. The beneficiary has distortion of the lower jaw or neck anatomy (e.g., radical neck dissection) such that a chin halter is unable to be utilized; or,

C. The treating physician orders and/or documents the medical necessity for greater than 20 pounds of cervical traction in the home setting.

Diagnosis: See LCD (Local coverage determination) at NGSMedicare.com for any additional qualifying information questions, diagnosis codes and descriptions

Medicare approved detailed equipment descriptions for Cervical Traction
Cervical traction, over door (HCPC-E0860)
Cervical traction, free standing  with or without Pneumatic or air bladder (HCPC’s E0850, E0855, E0849)

Patient notes/justification – Must be documented using your normal dictation process. Letter of medical necessity, notes wrote on letter head or prescriptions are not valid.

Prescription/order requirements – Must contain Patient’s name, date of the order and Start date, detailed equipment description (See above), signature of the ordering physician and a ignature date.