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.
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