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National Coverage Determination (NCD)

Electrical Stimulation for the Treatment of Wounds

35-102

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Tracking Information

Publication Number
6
Manual Section Number
35-102
Manual Section Title
Electrical Stimulation for the Treatment of Wounds
Version Number
2
Effective Date of this Version
04/01/2003
Ending Effective Date of this Version
07/01/2004
Implementation Date
04/01/2003
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. ES for the treatment of wounds is the application of electrical current through electrodes placed directly on the skin in close proximity to the wound. ES for the treatment of wounds will only be covered for chronic Stage III or Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers. All other uses of electrical stimulation for the treatment of wounds are noncovered. Chronic ulcers are defined as ulcers that have not healed within 30 days of occurrence. ES will not be covered as an initial treatment modality.
Indications and Limitations of Coverage

The use of electrical stimulation for the treatment of wounds is considered an adjunctive therapy. Electrical stimulation will be covered only after appropriate standard wound therapy has been tried for at least 30-days and there are no measurable signs of healing. This 30-day period can begin while the wound is acute. Measurable signs of improved healing include a decrease in wound size, either surface area or volume, decrease in amount of exudates and decrease in amount of necrotic tissue. Standard wound care includes: optimization of nutritional status; debridement by any means to remove devitalized tissue; maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings; and necessary treatment to resolve any infection that may be present. Standard wound care based on the specific type of wound includes: frequent repositioning of a patient with pressure ulcers (usually every 2 hours); off-loading of pressure and good glucose control for diabetic ulcers; establishment of adequate circulation for arterial ulcers; and the use of a compression system for patients with venous ulcers.

Continued treatment with electrical stimulation is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment. Electrical stimulation must be discontinued when the wound demonstrates 100 per-cent epithelialzed wound bed.

Any form of electromagnetic therapy for the treatment of chronic wounds will not be covered.

This service can only be covered when performed by a physician, physical therapist, or incident to a physician service. Evaluation of the wound is an integral part of wound therapy. When a physician, physical therapist, or a clinician incident to a physician, performs electrical stimulation, that practitioner must evaluate the wound and contact the treating physician if the wound worsens. If electrical stimulation is being used, wounds must be evaluated at least monthly by the treating physician.

Unsupervised use of electrical stimulation for wound therapy will not be covered, as this use has not been found to be medically reasonable and necessary.
Cross Reference
Claims Processing Instructions

Transmittal Information

Transmittal Number
161
Coverage Transmittal Link
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R161CIM.pdf
Revision History

11/2002 - Covered only for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers. Electrical stimulation not covered as an initial treatment modality. Electrical stimulation covered only after standard wound therapy has been tried for at least 30-days and there are no measurable signs of healing. Medicare will not cover any form of electromagnetic therapy for the treatment of chronic wounds. Effective and implementation dates 04/01/2003. (TN 161) (CR 2313)

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 You are here
Electrical Stimulation for the Treatment of Wounds 1 07/14/1997 - 04/01/2003 View
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CPT only copyright 2002-2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
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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