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.