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:
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:
- Galvanic Stimulation
- H-wave Stimulation
- 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
- Sympathetic Electrical Stimulation Therapy
- Interferential Current Stimulation (IFC or IFS)
- Transcutaneous Electrical Modulation Pain Reprocessing (TEMPR)
- Transcutaneous Electrical Stimulation (TENS)
The following Codes are discussed in this BC/BS Medicare Advantage Policy Manual:
E1399 E0731 E0744 E0745 E0761 E0762 E0764 E0769 E0770 G0281 G0282 G0295 G0329 S8130 S8131
*Status "N" codes - noncovered by either Medicare or Medicare Advantage policies.
CPT Codes: 0278T (Non-Covered Services L35008)
Electrical Stimulation therapies and codes NOT included “within the scope of this policy.”
E1399 (Sympathetic Electrical Stimulation Therapy)
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.
Click here to read the full BC/BS article and see a list of FDA approved electrical stimulation or electromagnetic therapy devices.