Other Services
Chapter 8
Section 5.2
Neuromuscular Electrical
Stimulation (NMES) Devices
Issue Date: July 8, 1998
Revision: C-53, September 27, 2019
1.0 DESCRIPTION
NMES devices contain a power supply (general
rechargeable batteries), a signal generator, a control circuit,
a modulating circuit and output circuit, and electrodes. Electrodes
may be superficial, percutaneous, or implanted. Functional electrical
stimulation is artificial electrical stimulation of muscles to produce
movements such as standing, walking, and grasping. NMES is used
to facilitate voluntary motor control and temporarily reduce spasticity
in patients suffering from spinal cord injury, cerebral palsy, or
other upper motor neuron disorders. NMES units are considered class
II devices.
2.0 POLICY
2.1 When used
in a program approved by the attending physician, NMES may be cost-shared
for the following indications:
2.1.1 For prevention and/or treatment
of disuse atroph
y,
where
nerve supply to the muscle is intact, due to a condition such as:
• Recent
hip surgery until the patient begins physical therapy, or
• Prolonged (greater than 12 weeks)
casting or splinting of a joint, or
• Contractures as a result of
scarring of soft tissue from burns.
2.1.2 For spinal
cord injury and other motor neuron disorders (such
as cerebral palsy) where nerve
supply to the muscle is intact; or
2.1.3 For idiopathic
scoliosis in pediatric and adolescent patients.
2.2 The device
is approved by the U.S. Food and Drug Administration (FDA) for commercial marketing
for a specific application and must be medically necessary for the
treatment of the condition for which the device is intended to be
used.
2.3 NMES devices approved by FDA (e.g., Parastep
I System, Respond II, etc.) may be cost-shared on an inpatient or
outpatient basis.
2.4 For other conditions, the
medical necessity of the equipment is required.
3.0 EXCLUSIONS
3.1 Neuromuscular
stimulators used by spinal cord-injured patients who have epilepsy,
cognitive deficiencies, osteoporosis, spasticity or other conditions
that could interfere with its safe use are excluded.
3.2 Claims
for neuromuscular stimulators used on denervated muscle should be
denied as unproven medical treatment or procedure.
3.3 Claims
for neuromuscular stimulators used as part of an exercise program
of healthy individuals (i.e., athletes) cannot be considered for
cost-sharing as this is not medically necessary service and supply
required in the diagnosis and treatment of an illness or injury.
3.4 The treatment
of scoliosis with implanted electrical muscle stimulation is considered
unproven and is not a covered benefit.
- END -