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A.2.01.57
Electrostimulation (electrical stimulation) 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 forwounds, generally chronic wounds.
Standard Treatment
Conventional or standard therapy for chronic wounds involves local wound care, as well as systemic measures including debridement of necrotic tissues, wound cleansing, and dressing that promotes a moist wound environment, antibiotics to control infection, and optimizing nutritional supplementation. Avoidance of weight-bearing is another important component of wound management.
ElectrostimulationSince the 1950's, investigators have used electrostimulation to promote wound healing, based on the theory that electrostimulation may:
Increase adenosine 5'-triphosphate concentration in the skin;
Increase DNA synthesis;
Attract epithelial cells and fibroblasts to wound sites;
Accelerate the recovery of damaged neural tissue;
Reduce edema;
Increase blood flow;
Inhibit pathogenesis.
Electrostimulation refers to the application of electrical current through electrodes placed directly on the skin near the wound. The types of electrostimulation and devices can be categorized into groups based on the type of current. This includes low-intensity direct current, high-voltage pulsed current, alternating current, and transcutaneous electrical nerve stimulation.
Electromagnetic TherapyElectromagnetic therapy is a related but distinct form of treatment that involves the application of electromagnetic fields, rather than direct electrical current.
No electrostimulation or electromagnetic therapy devices have received approval from the U.S. Food and Drug Administration specifically for the treatment of wound healing. A number of devices have been cleared for marketing for other indications. Use of these devices for wound healing is off-label.
Electrical stimulation for the treatment of wounds, including but not limited to, low-intensity direct current (LIDC), high-voltage pulsed current (HVPC), alternating current (AC), and transcutaneous electrical nerve stimulation (TENS), is considered investigational.
Electrical stimulation performed by individuals in the home setting for the treatment of wounds is considered investigational.
Electromagnetic therapy for the treatment of wounds is considered investigational.
Federal 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.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
7/27/2006: Approved by Medical Policy Advisory Committee (MPAC)
5/10/2007: Policy reviewed. Code reference section updated; HCPCS E0761, E0769, G0281, G0282, G0295, and G0329 added to non-covered codes
5/9/2008: Policy reviewed, no changes.
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions
04/13/2010: Policy description updated. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section.
12/30/2010: Policy description and statement unchanged. Removed the word "Chronic" from the policy title.
11/10/2011: Policy reviewed; no changes.
12/13/2012: Policy reviewed; no changes.
06/13/2013: Policy reviewed; no changes to policy statement. Removed diagnosis code 707 from the Code Reference section.
03/19/2014: Policy statement updated to add "for the treatment of wounds, including but not limited to" for clarity purposes only. Intent of policy statement unchanged.
10/27/2014: Policy reviewed; no changes.
07/20/2015: Code Reference section updated for ICD-10.
11/09/2015: Policy description updated. Policy statement updated to change "alternative current" to "alternating current." Policy guidelines updated to add investigative definition.
03/07/2016: Policy reviewed; no changes.
06/01/2016: Policy number A.2.01.57 added.
10/11/2017: Policy title updated to change "for the Treatment of Wounds" to "for Treating Wounds." Policy reviewed; no changes.
01/30/2018: Policy description updated to change "electrical stimulation" to "electrostimulation." Policy statements unchanged.
02/15/2019: Policy reviewed; no changes.
02/07/2020: Policy description updated to remove information regarding chronic wounds. Policy statements unchanged.
02/10/2021: Policy reviewed; no changes.
02/08/2022: Policy reviewed; no changes.
02/13/2023: Policy reviewed. Policy statement updated to change "patient" to "individuals."
02/09/2024: Policy reviewed; no changes.
03/05/2025: Policy reviewed; no changes.
Blue Cross Blue Shield Association Policy # 2.01.57
This may not be a comprehensive list of procedure codes applicable to this policy.
Code Number | Description |
CPT-4 | |
97032 | Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes |
HCPCS | |
E0761 | Non-thermal pulsed high-frequency radiowaves, high peak power electromagnetic energy treatment device |
E0769 | Electrical stimulation or electromagnetic wound treatment device, not otherwise classified |
E0770 | Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified |
G0281 | Electrical stimulation, (unattended), to one or more areas, for chronic stage III and stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care |
G0282 | Electrical stimulation, (unattended), to one or more areas, for wound care other than described in G0281 |
G0295 | Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses |
G0329 | Electromagnetic therapy, to one or more areas for chronic stage III and stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care |
ICD-10 Procedure | |
ICD-10 Diagnosis |
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