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Is COOLIEF* covered by Medicare?
COOLIEF* may be covered by Medicare and by certain private payers. However, your doctor will need to confirm with your insurance provider if they cover the COOLIEF* procedure.
How does the COOLIEF* procedure work?
This advanced procedure uses cooled radiofrequency energy to safely target the sensory nerves responsible for sending pain signals.1
A radiofrequency generator transmits a small current of RF energy through an insulated electrode, or probe, placed within tissue. Ionic heating, produced by the friction of charged molecules, thermally deactivates the nerves responsible for sending pain signals to the brain.
RF energy heats and cools the tissue at the site of pain.2-4
Unlike other RF procedures, COOLIEF* circulates water through the device while heating nervous tissue to create a larger treatment area, increasing the opportunity to help with pain. This combination targets the pain-transmitting nerves without excessive heating,5 leading to pain relief.1,6
What should I expect after the COOLIEF* procedure?
COOLIEF* is a viable option for many patients who aren’t ready or eligible for surgery. Compared to steroid injections, COOLIEF* has demonstrated improved pain relief, functionality, and patient satisfaction.
A short procedure can help you return to normal activities within a week or two. Follow your physician’s discharge instructions after the COOLIEF* procedure.
Using ice packs at the procedure site and taking analgesic medication (medication that temporarily alleviates pain) can decrease your discomfort.1,6
Potential complications associated with the use of this device include, but are not limited to, infection, nerve damage, increased pain, visceral injury, failure of technique, paralysis, and death.
What is chronic pain?
Chronic pain is different than regular pain. Usually the pain signal stops when the cause is resolved — for example, your body repairs the wound on your finger or your torn muscle. But with chronic pain, the nerve signals keep firing even after you’ve healed.
Your body keeps hurting weeks, months, or even years after the injury. Doctors often define chronic pain as any pain that lasts for 3 to 6 months or more.
Chronic pain can have real effects on your day-to-day life and your mental health. But you and your doctor can work together to treat it.
Do you need assistance with prior authorization or appeal?
COOLIEF* Patient Access Program
What is the COOLIEF* Patient Access Program?
Avanos has partnered with PRIA Healthcare to work directly with you, your provider, and your insurance company to obtain an approval for the COOLIEF* procedure, and to appeal any service denials until a final decision is determined. An approval cannot be guaranteed; however, we will continue to work on your behalf until all avenues are exhausted.
About PRIA Healthcare
The COOLIEF* Patient Access Program services are brought to you by Avanos and managed and operated by program partner PRIA Healthcare, an experienced third-party provider of patient access services.
The above information is provided as guidance only and does not constitute reimbursement or legal advice. It is not intended to increase or maximize reimbursement by third party payers. It is always the provider’s responsibility to determine medical necessity for a procedure, including number of levels/nerves denervated (if applicable), and to submit appropriate codes, charges, and modifiers for services that are rendered. Avanos Medical recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters.
Prior Authorization & Appeals Process
The COOLIEF* Patient Access Program will increase your access to treatment through the submission of comprehensive patient requests for prior authorization, internal patient-based appeals, up to, and including, an external review.
Request For Prior Authorization
Your healthcare provider will provide clinical documentation to support a letter of medical necessity to your insurance plan requesting prior authorization for the COOLIEF* cooled radiofrequency treatment. If your plan approves, no further action is required, and the procedure may be scheduled.
This process may take 15-30 days once the request is received.
The Internal Appeals Process
If your plan denies your prior authorization request, a COOLIEF* Patient Access Program Case Manager will submit an appeal letter and your clinical records on your behalf in an effort to demonstrate medical necessity. Our team will request up to two levels of internal appeals, however your plan may only require one level. If the plan approves, no further action is required, and the procedure may be scheduled.
This process may take 30-45 days after an appeal is submitted. If a second internal (Level 2) appeal is available, it may take an additional 30-45 days.
Your Right To An External Appeal
If your plan denies your internal appeal(s), you may have the right to request an External Review with an Independent Review Organization (IRO). A COOLIEF* Patient Access Program Case Manager will facilitate this process on your behalf. The decision of the IRO is binding.
This process may take 45-60 days once the external review request is submitted.
Please know that our team will continue to work diligently with you, your physician, and your insurer to obtain authorization for the COOLIEF* cooled radiofrequency treatment. We ask you to please be patient throughout the authorization and appeals process as it may take anywhere between 1-4 months from when your prior authorization is initially submitted. If you and your physician decide that the COOLIEF* is right for you, we stand ready to assist you.
Not sure if you’re ready for COOLIEF*? Talk with your primary physician using this guide. Remember, only a COOLIEF-trained specialist can perform this innovative procedure.
Find out more about OA knee pain and if COOLIEF* may be right for you.
Information about knee pain
- Osteoarthritis is a disease that damages the slippery tissue that covers the ends of bones in a joint. This allows bones to rub together, causing pain and stiffness.
- Osteoarthritis occurs most often in older people. Younger people sometimes get the disease after joint injuries.
- Knee pain can be caused by several things, such as bone spurs, cartilage fragments in meniscus fluid, or worn-away cartilage.
Information about back pain
- Back pain is one of the most common medical problems in the US.
- Acute pain is the most common type of back pain and lasts no longer than 6 weeks. Chronic pain can come on quickly or slowly and lasts a long time, generally longer than 3 months.
- Back pain is a symptom of a medical condition. It can get better even if you do not know the cause.
- Chronic back pain can occur in one or several locations of the back, including the cervical, thoracic, or lumbar areas. Speak with your doctor to identify the location of the pain and how to treat it.
There are COOLIEF*-trained specialists all across the country. Interested in an appointment?
I’m looking for a COOLIEF*-trained specialist for my pain near
- Kapural L, Nageeb F, Kapural M, et al. Cooled radiofrequency (RF) system for the treatment of chronic pain from sacroiliitis: The first case-series. Pain Pract. 2008;8:348-354.
- Pauza K. Cadaveric intervertebral disc temperature mapping during disc biacuplasty. Pain Physician. 2008;11:669-676.
- Kapural L, Hicks D, Mekhail N, et al. Histological changes and temperature distribution studies of a novel bipolar radiofrequency heating system in degenerate and nondegenerate human cadaver lumbar discs. Pain Med.2008;9:68-75.
- Petersohn JD, Conquergood LR, Leung M. Acute histologic effects and thermal distribution profile of disc biacuplasty using a novel water-cooled bipolar electrode system in an in vivo porcine model. Pain Med.2008;9:26-32.
- Gupta A. Evidence-based review of RF ablation techniques for chronic sacroiliac joint pain. Pain Med News. 2010;1-8.
- Kapural L. Intervertebral disc cooled bipolar radiofrequency (intradiskal biacuplasty) for the treatment of lumbar discogenic pain: a 12-month follow-up of the pilot study. Pain Med. 2008; 9:407-408.