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Coverage criteria policies

Iontophoresis

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for iontophoresis.

Coverage

Iontophoresis therapy is generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

Iontophoresis therapy is covered when all of the following criteria are met:

  1. When used as a supportive therapy as part of the standard medical care program; and
  2. When used for the delivery of dexamethasone; and
  3. When used for localized and superficial (depths of 1.5cm) inflammatory conditions; and
  4. When other conservative methods have failed or are not possible.

Indications that are not covered

  1. When used for relief of pain associated with herpes zoster.
  2. The use of iontophoresis in the home setting for any condition, including any type of hyperhidrosis, is considered self-help and is ineligible for coverage.

Definitions

Iontophoresis is the needle-free method of delivering certain types of medications into the skin by using a mild and direct current generated by a small electrical dose controller. Iontophoresis is also known as electrophoresis, ion therapy or ionic medication. Alternate names include, but are not limited to, Drionicâ„¢ Devices, Phonopheresis and Fischer MD-1.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

97033

Application of a modality to 1 or more areas; iontophoresis, each 15 minutes

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 10/31/1997 - Date of origin
  • 10/31/1997 - Effective date
Review date
  • 08/2015

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