Interferential Current Stimulation

POLICY NUMBER

A.1.01.24

DESCRIPTION

Interferentialcurrent stimulation is a type of electrical stimulation used to reduce pain. The technique has been proposed to decrease pain and increase function in individuals with osteoarthritis and to treat other conditions such as constipation, irritable bowel syndrome, dyspepsia, and spasticity.

Interferential current stimulation (IFS) uses paired electrodes of 2 independent circuits carrying high-frequency and medium-frequency alternating currents. The superficial electrodes are aligned on the skin around the affected area. It is believed that IFS permeates the tissues more effectively, with less unwanted stimulation of cutaneous nerves, and is more comfortable than transcutaneous electrical nerve stimulation. There are no standardized protocols for the use of IFS; IFS may vary by frequency of stimulation, the pulse duration, treatment time, and electrode-placement technique.

A number of IFS devices have been cleared for marketing by the U.S. Food and Drug Administration through the 510(k) process, including the Medstar™ 100 (MedNet Services) and the RS-4i® (RS Medical). IFS may be included in multimodal electrotherapy devices such as transcutaneous electrical nerve stimulation and functional electrostimulation.

TENS is discussed in the Transcutaneous Electrical Nerve Stimulator policy. Also, refer to the Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT) medical policy.

POLICY

Interferential current stimulation is considered investigational. 

POLICY EXCEPTIONS

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.

POLICY GUIDELINES

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. 

POLICY HISTORY

11/2002: 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.

07/29/2014: Added codes S8130 and S8131 to the Code Reference section.

01/15/2015: Policy description updated regarding the use of interferential current stimulation. Policy statement unchanged.

08/18/2015: Medical policy revised to add ICD-10 codes. Removed ICD-9 procedure code 99.86 from the Code Reference section.

04/26/2016: Policy Guidelines updated to revise investigative definition.

05/31/2016: Policy number A.1.01.24 added.

07/11/2016: Policy description updated. Policy statement unchanged.

10/10/2017: Policy description updated. Policy statement unchanged.

12/22/2017: Code Reference section updated to revise description for CPT code 64550 effective 01/01/2018.

06/26/2018: Policy description updated regarding devices. Policy statement unchanged.

12/27/2018: Code Reference section updated to make note of deleted CPT code 64550, effective 12/31/2018.

07/01/2019: Policy reviewed; no changes.

07/13/2020: Policy reviewed. Policy statements unchanged. Code Reference section updated to remove deleted CPT code 64550.

08/25/2021: Policy reviewed; no changes.

07/11/2022: Policy reviewed; no changes.

07/18/2023: Policy description updated to change "patients" to "individuals." Policy statement unchanged.

07/08/2024: Policy reviewed; no changes.

08/18/2025: Policy reviewed; no changes.

SOURCE(S)

Blue Cross Blue Shield Association policy #1.01.24

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.

Investigational Codes

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