Description

Electrical stimulation, also known as electrostimulation, refers to the application of electrical current through electrodes placed directly on the skin. Electromagnetic therapy involves the application of electromagnetic fields rather than direct electrical current. Both are proposed as treatments for wounds, generally chronic wounds.

Criteria

Electrical Stimulation

Electrical stimulation is covered for the management of the following types of chronic ulcers when it is used as adjunctive therapy after there are no measurable signs of healing for at least 30 days of treatment with conventional wound treatments (Electrical stimulation will not be covered as an initial treatment modality.):

• Arterial ulcers
• Diabetic ulcers
• Pressure ulcers (Stage III or Stage IV)
• Venous stasis ulcers

A course of electrical stimulation therapy for chronic ulcers would not typically be expected to exceed 60 minutes per day, or a total duration of more than one month.  Courses of electrical stimulation therapy for chronic ulcers exceeding 60 minutes per day are not considered medically necessary, as prolonged treatments beyond 60 minutes per day have not been proven to offer additional clinically significant benefits.

Continued treatment is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment. Measurable signs of improved healing include a decrease in wound size either in surface area or volume, decrease in amount of exudates, and decrease in amount of necrotic tissue. If electrical stimulation is being used, wounds must be evaluated at least monthly by the treating physician.

All other uses of electrical stimulation for the treatment of chronic ulcers will be denied as not medically necessary and, therefore, not covered.

Electrical stimulation for wound healing is not covered in the home setting, as unsupervised use by patients in the home has not been found to be medically necessary. Therefore, payment will not be made for an electrical stimulation device used to treat wounds.

Procedure Codes

Electromagnetic Therapy

Electromagnetic therapy is covered for the management of the following types of chronic ulcers when it is used as adjunctive therapy after there are no measurable signs of healing for at least 30 days of treatment with conventional wound treatments (Electromagnetic therapy will not be covered as an initial treatment modality.):

• Arterial ulcers
• Diabetic ulcers
• Pressure ulcers (Stage III or Stage IV)
• Venous stasis ulcers

Continued treatment is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment. Measurable signs of improved healing include a decrease in wound size either in surface area or volume, decrease in amount of exudates, and decrease in amount of necrotic tissue. If electromagnetic therapy is being used, wounds must be evaluated at least monthly by the treating physician.

All other uses of electromagnetic therapy for the treatment of chronic ulcers will be denied as not medically necessary and, therefore, not covered.

Electromagnetic therapy for wound healing is not covered in the home setting, as unsupervised use by patients in the home has not been found to be medically necessary. Therefore, payment will not be made for an electromagnetic wound treatment device used to treat wounds.

Electrical stimulation or electromagnetic therapy services that do not meet the medical necessity criteria on this policy will be considered not medically necessary.

It would not be appropriate for a patient to receive both electrical stimulation and electromagnetic therapy for the treatment of these wounds.

Procedure Codes

Noncontact Ultrasound Therapy

Noncontact ultrasound therapy for the treatment of chronic wound treatment is considered experimental/investigational. Scientific evidence does not support the effectiveness of this procedure.

Procedure Codes

Diagnosis Codes

Covered Dx codes for procedure codes G0281 and G0329