Electrical Stimulation and Electromagnetic Therapy Devices
By: Raquel Shumway Published: May 13th, 2019
Regence Blue Cross Blue Shield (Oregon Utah, Idaho, and select counties of Washington) has published a document regarding the Electrical Stimulation & Electromagnetic Therapy Devices. These guidelines take effect 05-01-2019.
Included in the document are the following reminders regarding Medicare and Medicare Advantage Medical Policies; reminders regarding non-covered services; Medicare Advantage policy criteria; types of stimulation; types of devices; codes and documentation.
The Medicare Advantage Medical Policies are:
Not intended to override the member Evidence of Coverage (EOC)
Not intended to tell providers how to practice medicine
Designed to provide guidance in the decision-making process both for covered and non-covered services
If there is no CMS guideline for a particular service/procedure, it is ok for the patient’s health plan to apply their policy or criteria.
The following services and procedures are excluded from coverage and the patient may be billed for them. Patients should be advised in advance that they may be responsible for these non-covered services.
Not medically necessary
Their Medicare Advantage Policy Criteria states the following:
Electrical stimulation or electromagnetic devices and procedures which require prior authorization are found on our “Medicare Preauthorization List” web page. Note that some electrical stimulation services may be reviewed externally by a vendor.
Specific electrostimulation and/or electromagnetic codes not listed on the prior authorization website do not require prior approval and may be considered medically necessary for Medicare Advantage.
Some forms of electrical stimulation may be addressed in other Medicare Advantage medical policies (see Cross References).
Providers remain responsible for correct coding, billing practices, and medical necessity whether or not there is a policy in place.
The Document covers the following Types of devices which are used “to relieve acute and chronic pain, alleviate symptoms caused by other medical conditions, treat muscle atrophy, provide ambulation in patients with a spinal cord injury, or in the treatment of wounds.”
Types of Stimulation and Devices:
Microcurrent Stimulation (MENS)
Functional Neuromuscular Electrical Stimulation (FES) Also known by other names
Threshold Electrical Stimulation
Cranial Electrostimulation Therapy (CES)
Electrostimulation and Electromagnetic Therapy for Wounds
Electrical Stimulation and Electromagnetic Therapy for Arthritis
S8130: S8131 (Interferential Current Stimulation — IFC or IFS)
According to BC/BS:
The information below must be submitted for review to determine whether policy criteria are met. If any of these items are not submitted, it could impact our review and decision outcome.
All chart notes and medical records pertinent to the request, including history and physical documenting the condition being treated and symptoms experienced.
Type of planned electrical stimulation and device name.
If the electrical stimulation is being used to treat wounds, the clinical documentation must include the type and stage of wound, attempted standard wound therapy, and whether or not measurable signs of improved healing exist (see Medicare NCD 270.1).
Click here to read the full BC/BS article and see a list of FDA approved electrical stimulation or electromagnetic therapy devices.
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