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National Coverage Determination (NCD)

Electrical Stimulation for the Treatment of Wounds

35-98

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Tracking Information

Publication Number
6
Manual Section Number
35-98
Manual Section Title
Electrical Stimulation for the Treatment of Wounds
Version Number
1
Effective Date of this Version
07/14/1997
Ending Effective Date of this Version
04/01/2003
Implementation Date
Implementation QR Modifier Date

Description Information

Benefit Category
Incident to a physician's professional Service
Outpatient Physical Therapy Services
Physicians' Services


Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

Electrical stimulation (ES) has been used or studied for many different applications, one of which is accelerating wound healing. The types of ES used for healing chronic venous and arterial wound and pressure ulcers are direct current (DC), alternating current (AC), pulsed current (PC), pulsed electromagnetic induction (PEMI), and spinal cord stimulation (SCS). An example of AC is transcutaneous electrical stimulation (TENS). The PEMI includes Pulsed Electromagnetic Field (PEMF) and Pulsed Electromagnetic Energy (PEE) using pulsed radio frequency energy, both of which are nonthermal i.e., they do not produce heat. Some ES use generators to create energy in the means such as coils, rather than by leads or surface electrodes.
Indications and Limitations of Coverage

There is insufficient evidence to determine any clinically significant differences in healing rates. Therefore, ES cannot be covered by Medicare because its effectiveness has not been adequately demonstrated.
Cross Reference
Claims Processing Instructions

Transmittal Information

Transmittal Number
100
Revision History

12/1997 - Suspended implementation of national coverage policy due to court decision in Aitken v Shalala. As a result of the court’s decision, CMS and its agents ordered to return to case-by-case evaluation regarding necessity and reasonableness of treatments. Includes all claims for services performed after July 14, 1997. (PM B-97-11)

05/1997 - Changed effective date for TN 95 to 07/14/1997. Effective date 07/14/1997. (TN 100)

05/1997 - Corrected pagination error. Effective date NA. (TN 98)

04/1997 - Provided noncoverage policy. Effective date 05/14/1997. (TN 95)
Other

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

Coding Analyses for Labs (CALs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with CALs, from the Coding Analyses for Labs database.

Additional Information

Other Versions
Title Version Effective Between
Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds 3 07/01/2004 - N/A View
Electrical Stimulation for the Treatment of Wounds 2 04/01/2003 - 07/01/2004 View
Electrical Stimulation for the Treatment of Wounds 1 07/14/1997 - 04/01/2003 You are here
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Reasons for Denial
Note: This section has not been negotiated by the Negotiated RuleMaking Committee. It includes CMS’s interpretation of it’s longstanding policies and is included for informational purposes. Tests for screening purposes that are performed in the absense of signs, symptoms, complaints, or personal history of disease or injury are not covered except as explicity authorized by statue. These include exams required by insurance companies, business establishments, government agencies, or other third parties. Tests that are not reasonable and necessary for the diagnosis or treatment of an illness or injury are not covered according to the statue. Failure to provide documentation of the medical necessity of tests may result in denial of claims. The documentation may include notes documenting relevant signs, symptoms, or abnormal findings that substantiate the medical necessity for ordering the tests. In addition, failure to provide independent verification that the test was ordered by the treating physician (or qualified nonphysician practitioner) through documentation in the physician’s office may result in denial. A claim for a test for which there is a national coverage or local medical review policy will be denied as not reasonable and necessary if it is submitted without an ICD-9-CM code or narrative diagnosis listed as covered in the policy unless other medical documentation justifying the necessity is submitted with the claim. If a national or local policy identifies a frequency expectation, a claim for a test that exceeds that expectation may be denied as not reasonable and necessary, unless it is submitted with documentation justifying increased frequency. Tests that are not ordered by a treating physician or other qualified treating nonphysician practitioner acting within the scope of their license and in compliance with Medicare requirements will be denied as not reasonable and necessary. Failure of the laboratory performing the test to have the appropriate Clinical Laboratory Improvement Act of 1988 (CLIA) certificate for the testing performed will result in denial of claims.
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