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Coverage criteria policies

Neuromuscular electrical stimulator (NMES)

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 required for neuromuscular electrical stimulator (NMES).


Neuromuscular electrical stimulators (NMES) are generally covered subject to the indications listed below, and per your plan documents.

Indications that are covered

  1. A neuromuscular electrical stimulator (NMES) will be covered for home use as an adjunct to physical therapy when:
    1. The device being provided has been successfully trialed in an appropriate clinical setting; and
    2. NMES is used for any of the following:
    3. Treatment of disuse atrophy where nerve supply to the muscle is intact, including brain, spinal cord, and peripheral nerves. There may also be non-neurological reasons for disuse atrophy. Examples would be casting or splinting of a limb, contracture due to scarring of soft tissue as in burn lesions and hip replacement surgery; or
    4. Motor re-education; or
    5. Decreasing spasticity, such as with cerebral palsy; or
    6. Maintaining or increasing joint range of motion.
  2. A neuromuscular stimulator will be covered initially for rental, up to the time the payments have reached the purchase price, at which time the machine becomes owned by the member.
  3. Associated supplies: electrodes and lead wires.
  4. A form-fitting conductive garment (E0731) is covered only when
    1. it is required to use the prescribed NMES device (e.g., Empi Phoenix, KneeHab devices), and
    2. the prescribed device meets all coverage criteria outlined in this policy.
  5. Other types of stimulator units (including but not limited to microcurrent and galvanic stimulation) require case by case review.

Indications that are not covered

  1. A NMES is not covered for pain control. Please see Related Content at right for link to TENS unit coverage policy.
  2. Four-channel NMES are not covered because they are not proven to be more effective than two channel devices.


Neuromuscular electrical stimulation (NMES) is the electrical stimulation of skeletal muscles through intact motor nerves to assist in the treatment of postural or movement disorders. The covered device is a two channel with two sets of leads allowing stimulation of two muscles or muscle groups.

Four channel NMES devices also are available, but there is no evidence that supports these as being more effective than the two channel devices. Consequently four channel NMES are not covered.

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.




Form-fitting conductive garment for delivery of TENS or NMES


Neuromuscular stimulator for scoliosis


Neuromuscular stimulator, electronic shock unit

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


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.


For in-network benefits to apply item must be received from a contracted specialty vendor or from the contracted clinic or specialty provider.


  1. Avramidis, K., Karachalios, T., Popotonasios, K., Sacorafas, D., Papathanasiades, A. A., Malizos, K. N. (2011). Does electric stimulation of the vastus medialis muscle influence rehabilitation after total knee replacement? Orthopedics, 34(3), 175. doi: 10.3928/01477447-20110124-06
  2. De Oliveira Melo, M., Aragdoa, F. A., Vaz, M. A. (2013). Neuromuscular electrical stimulation for muscle strengthening in elderly with knee osteoarthritis – a systematic review. Complementary Therapies in Clinical Practice, 19, 27-31.
  3. Stein, C., Fritsch, C. G., Robinson, C., Sbruzzi, G., & Plentz, R. D. M. (2015). Effects of electrical stimulation in spastic muscles after stroke: Systematic review and meta-analysis of randomized controlled trials. Stroke, 46, 2197-2205. doi: 10.1161/STROKEAHA.115.009633.)

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Policy activity

  • 11/29/1999 - Date of origin
  • 05/01/2018 - Effective date
Review date
  • 01/2018
Revision date
  • 12/29/2017

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