Electrical Stimulation Devices for the Treatment of Arthritis

Policy ID: E-46-020

Section: Durable Medical Equipment

Effective Date: July 01, 2018

Revised Date: July 12, 2022

Revision Effective Date: May 05, 2025

Last Reviewed: March 11, 2025

Applies To: Commercial and Medicaid Expansion

Description

Electrical stimulation has been used as an adjunctive therapy to improve functional status and relieve pain related to osteoarthritis and rheumatoid arthritis unresponsive to other standard therapies.

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.

Criteria

Electrical stimulation devices for the treatment of osteoarthritis or rheumatoid arthritis (e.g., BioniCare Stimulator System - Bio-1000 System) are considered experimental/investigational and therefore non-covered, because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Procedure Code

E0762

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 7-22-2020 Annual Review

Internal Medical Policy Committee 7-22-2021 Annual Review

Internal Medical Policy Committee 7-21-2022 Revision

Updated to clarifying language.

Internal Medical Policy Committee 3-19-2024 Annual Review-no changes in criteria

Added Policy Application

Internal Medical Policy Committee 3-11-2025 Annual Review-no changes in criteria

Updated references

Links

References (PDF)

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically.

Policy ID: E-46-019

Section: Durable Medical Equipment

Effective Date: July 01, 2018

Revised Date: July 12, 2022

Revision Effective Date: May 06, 2024

Last Reviewed: March 19, 2024

Archived Date: May 04, 2025

Applies To: Commercial and Medicaid Expansion

Description

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.

Criteria

Procedure Code

E0762

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 7-22-2020 Annual Review

Internal Medical Policy Committee 7-22-2021 Annual Review

Internal Medical Policy Committee 7-21-2022 Revision

Updated to clarifying language.

Internal Medical Policy Committee 3-19-2024 Annual Review-no changes in criteria

Added Policy Application

Medical Policies Quick Search

Electrical Stimulation Devices for the Treatment of Arthritis

Description

Policy Application

Criteria

Procedure Code

Diagnosis Codes

Professional Statements and Societal Positions Guidelines

ND Committee Review

Links

Disclaimer

Description

Policy Application

Criteria

Procedure Code

Diagnosis Codes

Professional Statements and Societal Positions Guidelines

ND Committee Review

Links

Disclaimer