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Electrical Stimulation Medical Policy Update Effective July 15, 2022

Audience: Neurology, Neurological Surgery, Pain Medicine, Psychology, Psychiatry providers

Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available on our website for review and comment here. Providers now have the capability of attaching supporting documentation related to their comments.

The following updated medical policy has been reviewed and was approved on March 21, 2022, by the Corporate Medical Policy Committee, including practitioner representatives from all Health Plan regions. The updated policy will be effective July 15, 2022. The policy applies to all lines of business and to the services of all practitioners and facilities.

Corporate Medical Policy 1.01.01 – Transcutaneous and Percutaneous Electrical Nerve Stimulation replaces 1.01.01 Electrical Stimulation: Transcutaneous Electrical Nerve, Percutaneous Electrical Nerve, H-WAVE, and Interferential Stimulation. The policy has been updated to reflect Centers for Medicare & Medicaid Services coding changes, address new technology that has been approved by the U.S. Food and Drug Administration.

The Transcutaneous and Percutaneous Electrical Nerve Stimulation as a Treatment for Pain and other Conditions policy provides updates to the criteria for all indications:

Remote electrical neuromodulation devices (e.g., nerivio), external upper limb tremor stimulators (e.g., cala trio), and cranial electrical stimulation (e.g., alpha stim-aid) are considered investigational.

The rationale section of the medical policy provides information related to the Health Plan’s change in coverage criteria based on an assessment of the peer-reviewed literature. 

These services are subject to audit and policy updates at the Health Plan’s discretion. Access the individual policies here.

If you have any questions regarding this policy, please contact your Provider Relations representative.

Thank you for the quality of care and service that you provide to our members.

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