| Coverage Decisions for Medical Technologies & Procedures |  | |
Neuromuscular electrical stimulators (NMES)
Coverage decision
L&I covers neuromuscular electrical stimulator (NMES) when used in a clinical setting. Treatment is limited to care that is "proper and necessary", by the rules for physical therapy treatment and for physical medicine treatment.
Coverage for NMES devices for home use is limited and will be approved only after fulfilling certain criteria. This policy applies to L&I and self-insurers.
What is considered a NMES device?
NMES devices send an electrical stimulus to motor nerves or muscles causing muscle contraction. They are used to:
- Strengthen and train healthy muscles at risk of atrophy due to immobilization or disuse following injury, or
- Stimulate denervated muscles to prevent atrophy and degeneration.
Payment for NMES devices is limited to those who are approved by the Food and Drug Administration (FDA) as NMES devices.
What are the limits for home use?
Home use of NMES requires pre-authorization.
Approval for home use requires the following conditions are met:
- The patient has suffered partial or complete loss of function in 1 or more muscles due to of an injury to a peripheral nerve or nerve root, and
- Denervation is substantiated by electromyogrpahy (EMG). The EMG must demonstrate positive waves and/or fibrillation in the affected muscles.
For L&I workers' comp claims, an L&I medical consultant must review the documentation and confirm that at-home use of NMES is medically necessary. The medical consultant will recommend an time frame for use of the device based upon the injury.
What are the limits for a clinical setting?
Pre-authorization is not required for use of NMES in the clinical setting. NMES is 1 of several physical therapy modalities that may be used in the clinical setting without pre-authorization. Use of physical therapy is limited in number of treatment visits the patient may receive and not by the number of modalities used.
What are the limits of physical therapy?
For information, on physical therapy pre-authorization requirements please see our Physical, Occupational & Massage Therapy site.
For more information:
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