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DESCRIPTIONInterferential stimulation (IFS) is a type of electrical stimulation. It is believed that IFS permeates the tissues more effectively and thus is more comfortable than transcutaneous electrical nerve stimulation (TENS). Interferential stimulation has been investigated as a technique to reduce pain, improve range of motion, or promote local healing following various tissue injuries.
Interferential stimulation (IFS) is a type of electrical stimulation that uses paired electrodes of 2 independent circuits carrying high-frequency (4,000 Hz) and medium-frequency (150 Hz) alternating currents. The superficial electrodes are aligned on the skin around the affected area. It is believed that IFS permeates the tissues more effectively and, with less unwanted stimulation of cutaneous nerves, is more comfortable than transcutaneous electrical stimulation (TENS). Interferential stimulation has been investigated as a technique to reduce pain, improve range of motion, or promote local healing following various tissue injuries. There are no standardized protocols for the use of interferential therapy; the therapy may vary according to the frequency of stimulation, the pulse duration, treatment time, and electrode-placement technique.
A number of interferential stimulator devices have received 510(k) marketing clearance from the U.S. Food and Drug Administration (FDA), including the Medstar™ 100 (MedNet Services) and the RS-4i® (RS Medical).
TENS is discussed in the Transcutaneous Electrical Nerve Stimulator policy. Also, refer to the Percutaneous Electrical Nerve Stimulation (PENS) or Percutaneous Neuromodulation Therapy (PNT) medical policy.
POLICYInterferential current stimulation is considered investigational.
POLICY EXCEPTIONSFederal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY11/2002: Approved by Medical Policy Advisory Committee (MPAC)
8/5/2005: Code Reference section reviewed, no changes
2/24/2006: Policy review; no changes
03/30/2006: Code Reference section updated. CPT4, HCPC, ICD9 codes added to policy
9/12/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
5/7/2008: Policy updated with literature review; policy statement unchanged. Policy renamed "Interferential Stimulation"; previously named "Interferential Therapy for Pain and Bone Fractures"
04/14/2010: “For treatment of pain” added to the title and policy statement; intent of policy statement unchanged. Policy description updated. FEP verbiage added to the Policy Exceptions section. Outdated references deleted from the Sources section.
12/28/2010: Policy reviewed; no changes.
01/18/2012: Policy reviewed; no changes.
03/13/2013: Policy title changed from "Interferential Stimulation for Treatment of Pain" to "Interferential Current Stimulation." The verbiage "for the treatment of pain" was deleted from the policy statement due to the expanded scope of policy.
03/07/2014: Policy reviewed; no changes.
SOURCE(S)Blue Cross Blue Shield Association policy #1.01.24
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.