Highmark Medical Policy Bulletin |
Section: | Miscellaneous |
Number: | Z-7 |
Topic: | Electrical Nerve Stimulation |
Effective Date: | March 18, 2002 |
Issued Date: | March 18, 2002 |
Date Last Reviewed: | 12/2001 |
Coverage of electrical nerve stimulation is limited to those stimulators and situations defined within this policy when used to alleviate chronic intractable pain, unless otherwise stated. CENTRAL NERVOUS SYSTEM
PERIPHERAL NERVOUS SYSTEM
NOTE: See Medical Policy Bulletin S-131 for guidelines on sacral nerve stimulation. |
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61862 | 61885 | 61886 | 63650 | 63655 | 63660 |
63685 | 63688 | 64550 | 64555 | 64573 | 64575 |
64577 | 64585 | 64590 | 64595 | 95970 | 95971 |
95972 | 95973 | 95974 | 95975 |
Traditional (UCR/Fee Schedule) Guidelines
TENS is considered eligible for coverage for treatment of acute postoperative pain and for treatment of severe and chronic pain. For chronic pain, TENS has an assessment period of one week. For acute postoperative pain, rental of the stimulator should be limited to seven days. Anything in excess of seven days should be given individual consideration. |
Comprehensive/Wraparound/PPO Guidelines
Managed Care (HMO/POS) Guidelines
PRN References |
Long-term transcutaneous electrical nerve stimulation (TENS) use: impact on medication utilization and physical therapy costs, Clin J Pain, Vol. 14, Issue 1, 03/1998 |
[Version 002 of Z-7] |
[Version 001 of Z-7] |
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