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.
Prior authorization is required for neuromuscular electrical stimulator (NMES).
Prior authorization is not applicable for functional electrical stimulation (FES) in the home because it is considered investigational/experimental. The provider and facility will be liable for payment unless:
- the provider notifies the member that a specific service has been determined by HealthPartners to be investigational/experimental; and
- the member signs a waiver agreeing to pay for the specific non-covered service being rendered; and
- the claim has been billed with a GA modifier indicating such. If the member has signed a waiver agreeing to pay for the specific service then the member will be liable for payment.
Neuromuscular electrical stimulators (NMES) are generally covered subject to the indications listed below, and per your plan documents.
Functional Electrical Stimulation (FES) in the home is not covered, as it is considered investigational/experimental.
The scope of this policy is limited to the home use of FES. FES may be covered when used as part of a facility-based rehabilitative physical therapy program, when the condition is acute and significant improvement is expected within a predictable period of time (generally within 60 days) as a result of therapy. Please see related content at the right for link to the Physical & occupational therapy - rehabilitation coverage policy for details.
- A neuromuscular electrical stimulator (NMES) will be covered for home use as an adjunct to physical therapy when:
- The device being provided has been successfully trialed in an appropriate clinical setting; and
- NMES is used for any of the following:
- 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
- Motor re-education; or
- Decreasing spasticity, such as with cerebral palsy; or
- Maintaining or increasing joint range of motion.
- 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.
- Associated supplies: electrodes and lead wires.
- A form-fitting conductive garment (E0731) is covered only when
- it is required to use the prescribed NMES device (e.g., Empi Phoenix, KneeHab devices), and
- the prescribed device meets all coverage criteria outlined in this policy.
- Other types of stimulator units (including but not limited to microcurrent and galvanic stimulation) require case by case review.
- An NMES is not covered for pain control. Please see Related Content at right for link to TENS unit coverage policy.
- Four-channel NMES are not covered because they are not proven to be more effective than two channel devices.
FES (included for informational purposes only, list may not be all inclusive)
- Upper extremity FES devices such as the NESS H200 and Handmaster (made by Bioness) are not covered for in-home use, either rental or purchase.
- Lower extremity FES devices such as the Parastep System, NESS L300, WalkAide, Odstock Dropped Foot Stimulator are not covered for in-home use, either rental or purchase.
- In-home stationary exercise FES devices such as the RT300 cycle ergometer (Restorative Therapies, Inc.) and ERGYS I (Therapeutic Alliance, Inc.) are not covered as they are considered to be exercise equipment.
- FES therapy for the purpose of maintaining physical condition or maintenance therapy for a chronic condition is not covered (both in-home use and as part of a facility based rehabilitative PT program). Examples include, but are not limited to:
- prevention of lower extremity atrophy
- to assist maintenance of cardiovascular conditioning/endurance
- prevention of decubiti OR bladder infections OR pulmonary complications
- to maintain bone mineralization
- to maintain or increase range of motion
- correction of gait disorders
- to relax muscle spasms
Functional Electrical Stimulation (FES) is used to enhance functional activity in neurologically impaired patients. These devices send electrical impulses to activate paralyzed or weak muscles in precise sequence, in an attempt to stimulate a muscle disabled after a neurological event such as spinal cord injury, multiple sclerosis, stroke, etc.
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
Functional neuromuscular stimulator, transcutaneous stimulation of muscles of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program
Functional stimulator, transcutaneous stimulation of nerve and / or muscle groups, any type, complete system, not otherwise specified
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.
- Barkoudah, E., & Glader, L. Cerebral palsy: Treatment of spasticity, dystonia, and associated orthopedic issues. In: UpToDate, Bridgemohan, C., Patterson, M. C., & Phillips, W. A. (Eds), UpToDate, Waltham, MA. (Accessed on January 22, 2019.)
- Barrett, C. L., Mann, G. E., Taylor, P. N., & Strike, P. (2009). A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with multiple sclerosis. Multiple Sclerosis, (15), 493–504. DOI: 10.1177/1352458508101320.
- 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. http://dx.doi.org/10.1016/j.ctcp.2012.09.002
- ECRI Institute. (2016). Functional electrical stimulation for rehabilitation of children with central nervous system disorders or injuries causing muscle paralysis. Plymouth Meeting, PA: ECRI Institute.
- Hayes, Inc. Hayes Medical Technology Directory Report. Functional Electrical Stimulation (FES) for Upper Extremity Rehabilitation Post Stroke. Lansdale, PA: Hayes, Inc.; July, 2009. Archived August, 2014.
- Hayes, Inc. Hayes Medical Technology Directory Report. Functional Electrical Stimulation for Rehabilitation Following Spinal Cord Injury. Lansdale, PA: Hayes, Inc.; November, 2017. Reviewed November, 2018.
- Hayes, Inc. Hayes Medical Technology Directory Report. Neuromuscular Electrical Stimulation for Rehabilitation in Patients with Cerebral Palsy. Lansdale, PA: Hayes, Inc.; December, 2010. Archived January, 2016.
- Hayes, Inc. Hayes Health Technology Brief. Functional Electrical Stimulation (FES) for Treatment of Foot Drop in Multiple Sclerosis Patients. Lansdale, PA: Hayes, Inc.; July, 2015. Archived August, 2018.
- Kerr, C., McDowell, B., Cosgrove, A., Walsh, D., Bradbury, I., & McDonough, S. (2006). Electrical stimulation in cerebral palsy: a randomized controlled trial. Developmental Medicine & Child Neurology, 48, 870–876.
- Kluding, P. M., Dunning, K., O’Dell, M. W., Wu, S. S., Ginosian, J., Feld, J., & McBride, K. (2013). Foot drop stimulation versus ankle foot orthosis after stroke: 30-week outcomes. Stroke, (44), 1660-1669.
- Pomeroy, V. M., King, L. M., Pollock, A., Baily-Hallam, A., & Langhorne, P. (2006). Electrostimulation for promoting recovery of movement or functional ability after stroke: systematic review and meta-analysis. Stroke, 37, 2441-2442. doi: 10.1161/01.STR.0000236634.26819.cc
- Springer, S., & Khamis, S. (2017). Effects of functional electrical stimulation on gait in people with multiple sclerosis – a systematic review. Multiple Sclerosis and Related Disorders, 13, 4–12. http://dx.doi.org/10.1016/j.msard.2017.01.010.
- 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.
- van Peppen, R. P. (2008). Towards evidence-based physiotherapy for patients with stroke. Utrecht University.
- van Swigchem, R., Vloothuis, J., den Boer, J., Weerdesteyn, V., & Geurts, A. C. (2010). Is transcutaneous peroneal stimulation beneficial to patients with chronic stroke using an ankle-foot orthosis? A within-subjects study of patients' satisfaction, walking speed and physical activity level. Journal of Rehabilitation Medicine, 42(2), 117-21.
- 02/15/2019 - Date of origin
- 03/01/2019 - Effective date