Cigna Policy Updates: Electrical Stimulation and Advance ROM Effective May 20th.

Cigna has updated the Electrical Stimulation and Advance ROM medical policy effective May 20, 2013.

The original effective date of May 15th was delayed.

Neuromuscular Electrical Stimulation (NMES)

  • • Cigna covers neuromuscular electrical stimulation when used as one component of a comprehensive rehabilitation program for the treatment of disuse atrophy when the nerve supply to the atrophied muscle is intact.
  • • Cigna does not cover neuromuscular electrical stimulation (NMES) for ANY other indication because it is considered experimental, investigational or unproven.
  • • HCPCS code E0745 will only be covered when billed with ICD-9 code 728.2.
  • • HCPCS code E0745 will not be covered when billed with any other ICD-9 code, as it is considered EIU.

TENS

  • • Cigna covers a transcutaneous electrical nerve stimulator (TENS) as medically necessary as an adjunct to conventional post-operative pain management within 30 days of surgery.
  • • Cigna does not cover TENS for ANY other indication, because it is considered experimental, investigational or unproven.

Conductive Garment

  • • Cigna covers a conductive garment (HCPCS Code E0731) as medically necessary when used in conjunction with medically necessary NMES or TENS for ANY of the following clinical situations:
    • o The use of conventional electrodes, tapes or lead wires is not feasible either because the individual has a large area requiring treatment or a large number of sites requiring stimulation.
    • o The site(s) requiring stimulation (i.e., back) is/are difficult to reach with conventional electrodes, tapes or lead wires.
    • o A co-existing medical condition (e.g., skin problems) precludes the use of conventional electrodes, tapes, or lead wires.
    • o Cigna does not cover a conductive garment for any other indication because it is considered not medically necessary.

Advanced ROM

  • • Cigna does not cover the use of a low load prolonged-duration stretch (LLPS) device for any other condition or for any joint other than a finger joint (HCPCS codes E1800, E1802, E 1805, E1810, E1812, E1815, E1830, E1840) because it is considered experimental, investigational or unproven.

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