Clinical UM Guideline
Subject: Cervical Traction Devices for Home Use
Guideline #: CG-DME-05 Publish Date: 07/06/2022
Status: Reviewed Last Review Date: 05/12/2022
Description

This document addresses the different devices used in the home for cervical traction, including “over-the-door” and pneumatic devices.

Intermittent cervical traction is an accepted technology for treatment of a variety of musculoskeletal disorders of the neck, including but not limited to neck muscle spasm (such as whiplash), radiculopathy, discogenic pain and degenerative changes.

Clinical Indications

Medically Necessary:

An “over the door” home cervical traction device is considered medically necessary provided both of the criteria below are met:

Not Medically Necessary:

Other designs of home cervical traction units, including but not limited to, pneumatic devices, frames attached to headboards, or freestanding units are considered not medically necessary.

Coding

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services may be Medically Necessary when criteria are met:

HCPCS

 

E0860

Traction equipment, over door, cervical

 

 

ICD-10 Diagnosis

 

 

All diagnoses

When services are Not Medically Necessary:
For the procedure code listed above when criteria are not met.

When services are also Not Medically Necessary:
For the following procedure codes; or when the code describes a procedure designated in the Clinical Indications section as not medically necessary.

HCPCS

 

E0840

Traction frame, attached to headboard, cervical traction

E0849

Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible

E0850

Traction stand, free-standing, cervical traction

E0855

Cervical traction equipment not requiring additional stand or frame

E0856

Cervical traction device, with inflatable air bladder(s)

 

 

ICD-10 Diagnosis

 

 

All diagnoses

Discussion/General Information

Neck pain is a common occurrence that affects many people during their lifetime. The American College of Rheumatology (ACR, 2015) noted that on an annual basis, approximately 30% of the population experiences an occurrence of neck pain. Typically, neck pain is acute and improves within 1 to 2 weeks with conservative treatments, which may include heat, ice, massage, stretching and pain relievers. The majority of the neck pain resolves within 8 to 12 weeks (ACR, 2015; van der Heijden, 1995). However, almost half of individuals with neck pain will have residual pain or experience frequent reoccurrences (Cohen, 2015).

Traction is a treatment modality in which opposite forces are applied to separate parts of the body to stretch soft tissues, and/or separate bony structures. It has been proposed that cervical traction results in an expansion of the intervertebral spaces, an increase in joint mobility, and stretching of muscles and ligaments adjacent to the vertebral bodies, potentially improving the clinical outcomes in those with neck pain. After 2 minutes of sustained traction, the intervertebral spaces begin to widen. Forces between 20 and 50 pounds are frequently used to achieve intervertebral separation. Continuous or static traction can be applied in a steady amount for specific time periods. Intermittent or cyclical traction involves traction being applied and released multiple times during one treatment session. Duration of cervical traction can range from a few minutes to 20 to 30 minutes, once or twice weekly to multiple times per day. In addition to office-based traction, individuals with long-standing pain may benefit from home-based traction.

A variety of cervical traction devices are available for use in the home. The most commonly used device employs an over the door design, in which an individual wears a chin strap harness attached to a counterweight that is suspended over a door using a pulley system. The counterweight pulls the chin harness upwards, extending the neck. Over-the-door units are designed to deliver no more than 20 pounds of tension. Variations of this device using the counterweight and pulley system include frames which attach to a headboard or freestanding units.

Pneumatic devices are designed to be used in the supine position with the device beneath the head and shoulders and a strap or straps holding the head in place. User controlled pumps or bellows allow the individual to increase the tension, pulling the head away from the body. This extends the neck, stretches the affected muscles and increases the intervertebral spaces. Pneumatic devices typically can deliver up to 50 pounds of tension.

When used with other standard modalities, traction may result in greater improvements in mobility and pain compared to standard therapy alone (van der Heijden, 1995; Zylbergold, 1985). While the quality of existing evidence is low, involving small studies with limited follow-up and generally inconclusive results, the totality of data is generally supportive (Graham, 2006; Graham; 2008; Young, 2009). The use of “over the door” home cervical traction devices is a generally accepted modality for the treatment of musculoskeletal or neurologic impairment requiring traction equipment.

In a meta-analysis of seven randomized controlled trials (RCTs), Yang and associates (2017) evaluated the effectiveness of intermittent cervical traction (ICT) in relieving neck pain. A total of seven RCTs (n=402) were included in the analysis. The ICT groups reported lower pain scores immediately following the treatment course, there was no difference at the final follow-up (standard mean differences [SMD]=-0.57; 95% confidence interval [CI], -1.46 to 0.32; I2=83%). The authors concluded that ICT might result in short-term neck pain.

In an RCT, Fritz and colleagues (2014) evaluated the effectiveness of cervical traction in the treatment of cervical radiculopathy. A total of 86 adults with a primary complaint of neck pain with pain or numbness were randomized to one of three treatment groups: exercise, exercise and mechanical traction in the clinical setting or exercise with a home over-door traction device. Median symptom duration was 53 days with 33 (38.4%) individuals reporting presence of symptoms greater than 6 weeks and 11 (12.8%) reporting presence of symptoms greater than 1 year. Participants received 10 physical therapy sessions over 4 weeks, with follow-up assessments completed at 4 weeks, 6 months and 12 months by a researcher blinded to the individual treatment groups. All participants were given the same exercise regimen. Intention-to-treat analyses for the primary outcome (neck disability index [NDI] score) at 6 months showed lower scores in mechanical traction compared to exercise group only (mean difference 13.3; 95% CI: 5.6, 21.0; p=0.001) and over-door traction group (mean difference 8.1; 95% CI: 0.8, 15.3; p=0.031). At 12 months, lower NDI scores persisted in the mechanical traction verses exercise group (mean difference 9.8; 95% CI: 0.2, 19.4; p=0.046). Mechanical traction showed lower neck pain intensity scores compared to the exercise only group at 6 months (mean difference 1.9; 95% CI: 0.7, 3.2; p=0.003) and the over-the-door traction group (mean difference 1.2; 95% CI: 2.4, 0.03; p=0.045). At 6 months, arm pain scores were lower for the over-the-door group compared to the exercise only group (mean difference 2.2; 95% CI: 0.8, 3.7; p=0.004). There were no differences in arm pain between groups at 12 months. Individuals reporting a successful outcome based on a global rating score were 53 (61.6%) at 4 weeks, 32 (37.2%) at 6 months and 35 (40.7%) at 12 months. These results generally favored the traction groups as compared to exercise only group; however, they were not statistically significant at any of the follow-up. The authors noted that the addition of cervical traction to a standard exercise program resulted in lower NDI and pain intensity scores in individuals with cervical radiculopathy, particularly in those individuals who received mechanical traction in the office setting. However, results showed additional benefit in the over-door traction group over the exercise only group as well, especially in those who were comfortable with the device.

Pneumatic devices are able to provide more pounds of tension, or force, versus the over-the-door traction devices. However, there is also a lack of consensus in the published literature regarding optimum and safe tension amounts, duration and frequency of traction. Currently there is a paucity of evidence to support pneumatic devices as clinically appropriate home cervical traction devices.  

References

Peer Reviewed Publications:

  1. Borman P, Keskin D, Ekici B, Bodur H. The efficacy of intermittent cervical traction in patients with chronic neck pain. Clin Rheumatol. 2008; 27(10):1249-1253.
  2. Bryans R, Decina P, Descarreaux M, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther. 2014; 37(1):42-63.
  3. Chiu TT, Ng JK, Walther-Zhang B, et al. A randomized controlled trial on the efficacy of intermittent cervical traction for patients with chronic neck pain. Clin Rehabil. 2011; 25(9):814-822.
  4. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015; 90(2):284-299.
  5. Colombo C, Salvioli S, Gianola S, et al. Traction therapy for cervical radicular syndrome is statistically significant but not clinically relevant for pain relief. A systematic literature review with meta-analysis and trial sequential analysis. J Clin Med. 2020; 9(11):3389.
  6. Fritz JM, Thackeray A, Brennan GP, Childs JD. Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther. 2014; 44(2):45-57.
  7. Joghataei MT, Arab AM, Khaksar H. The effect of cervical traction combined with conventional therapy on grip strength on patients with cervical radiculopathy. Clin Rehabil. 2004; 18(8):879-887.
  8. Klaber-Moffett JA, Hughes GI, Griffiths P. An investigation of the effects of cervical traction. Part 1: Clinical effectiveness. Clin Rehabil. 1990; 4(3):205-211.
  9. Salt E, Wright C, Kelly S, Dean A. A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain. Man Ther. 2011; 16(1):53-65.
  10. Swezey RL, Swezey AM, Warner K. Efficacy of home cervical traction therapy. Am J Phys Med Rehab. 1999; 78(1):30-32.
  11. Thoomes EJ, Scholten-Peeters W, Koes B, et al. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain. 2013; 29(12):1073-1086.
  12. van der Heijden GJ, Beurskens AJ, Koes BW, et al. The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods. Phys Ther. 1995; 75(2):93-104.
  13. van Tulder M, Furlan A, Bombardier C, Bouter L.; Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine (Phila Pa, 1976). 2003; 28(12):1290-1299.
  14. Waylonis GW, Tootle D, Denhart C, et al. Home cervical traction: evaluation of alternate equipment. Arch Phys Med Rehabil. 1982; 63(8):388-391.
  15. Yang JD, Tam KW, Huang TW, et al. Intermittent cervical traction for treating neck pain: a meta-analysis of randomized controlled trials. Spine (Phila Pa 1976). 2017; 42(13):959-965.
  16. Young IA, Michener LA, Cleland JA, et al. Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther. 2009; 89(7):632-642.
  17. Zylbergold RS, Piper MC. Cervical spine disorders. A comparison of three types of traction. Spine. 1985; 10(10):867-871.

Government Agency, Medical Society, and Other Authoritative Publications:

  1. Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Durable Medical Equipment Reference List. NCD #280.1. Effective May 5, 2005. Available at: https://www.cms.gov/medicare-coverage-database/new-search/search.aspx. Accessed on March 28, 2022.
  2. Childs JD, Cleland JA, Elliott JM, et al. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthapaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008; 38(9):A1-A34.
  3. Graham N, Gross A, Goldsmith CH, et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database Syst Rev. 2008; (3):CD006408.
  4. Graham N, Gross AR, Goldsmith C.; the Cervical Overview Group. Mechanical traction for mechanical neck disorders: a systematic review. J Rehabil Med. 2006; 38(3):145-152.
  5. Gross A, Forget M, St George K, et al. Patient education for neck pain. Cochrane Database Syst Rev. 2012; (3):CD005106.
  6. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Noninvasive nonpharmacological treatment for chronic pain: A systematic review update. Comparative Effectiveness Review No. 227. April 2020. Available at: https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/noninvasive-nonpharm-pain-update.pdf. Accessed on March 28, 2022.
  7. Washington State Department of Labor and Industries Technology Assessment. Pronex and HomeTrac Cervical Traction. August 5, 2002. Available at: https://www.lni.wa.gov/patient-care/treating-patients/treatment-guidelines-and-resources/_docs/PronexAndSaundersTA.pdf. Accessed on March 28, 2022.
Websites for Additional Information
  1. American College of Rheumatology (ACR). Neck Pain. Updated December 2020. Available at: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Living-Well-with-Rheumatic-Disease/Neck-Pain. Accessed on March 28, 2022.
  2. National Institutes of Health (NIH). MedlinePlus.
Index

ComforTrac
HomeTrac
Pratos
Pronex
Saunders

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

History

Status

Date

Action

Reviewed

05/12/2022

Medical Policy & Technology Assessment Committee (MPTAC) review. Updated Discussion and References sections.

Reviewed

05/13/2021

MPTAC review. Updated Discussion and References sections. Reformatted Coding section.

Reviewed

05/14/2020

MPTAC review. Updated References and Websites sections.

Reviewed

06/06/2019

MPTAC review. Updated References and Websites sections.

Reviewed

07/26/2018

MPTAC review. Updated Discussion, References and Website sections.

 

05/02/2018

The document header wording updated from “Current Effective Date” to “Publish Date.”

Reviewed

08/03/2017

MPTAC review. Updated Discussion, References and Website sections.

Revised

08/04/2016

MPTAC review. Revision to Clinical Indications criteria from “he/she” to “that individual”. Updated Rationale, References and Website sections. Updated formatting in Clinical Indications section. Removed ICD-9 codes from Coding section.

Reviewed

08/06/2015

MPTAC review. Updated Rationale, References and Website sections.

 

01/01/2015

Updated Coding section with 01/01/2015 HCPCS change to descriptor for E0856.

Reviewed

08/14/2014

MPTAC review. Updated References and Website sections.

Reviewed

08/08/2013

MPTAC review. Updated References, Discussion and Website sections.

Reviewed

08/09/2012

MPTAC review. Updated References, Discussion and Website sections.

Reviewed

08/18/2011

MPTAC review. Updated References, Coding, Discussion and Website sections.

Reviewed

08/19/2010

MPTAC review. Updated References, Discussion and Website sections.

Reviewed

08/27/2009

MPTAC review. Updated References and Discussion. Removed Place of Service Section.

Reviewed

08/28/2008

MPTAC review. Updated References and Discussion.

Reviewed

01/01/2008

Updated coding section with 01/01/2008 HCPCS changes.

Reviewed

08/23/2007

MPTAC review. Description and References updated.

Reviewed

09/14/2006

MPTAC review. References updated. Coding updated; removed HCPCS K0627 deleted 12/31/04.

 

11/17/2005

Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).

Revised

09/22/2005

MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.

Pre-Merger Organizations

Last Review Date

Document Number

Title

 

Anthem BCBS West Region

09/22/2004

DME.215

Cervical Traction Devices

WellPoint Health Networks, Inc.

12/02/2004

9.07.04

Cervical Traction Devices for Home Use


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