Interferential Current Stimulation for the Treatment of Pain
DESCRIPTION
Interferential current stimulation (ICS) 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. ICS has been investigated as a technique to reduce pain, improve range of motion (ROM), or promote local healing following various tissue injuries. There are no standardized protocols for the use of interferential current therapy. The therapy may vary according to the frequency of stimulation, the pulse duration, treatment time, and electrode-placement technique.
Examples of interferential current stimulation devices include the: Medstar™ 100 (MedNet Services), SporTX Stimulator and the RS-4i® (RS Medical).
POLICY
Interferential current stimulation for the treatment of pain is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Any device utilized for interferential current stimulation must have FDA approval specific to the indication, otherwise its use will be considered investigational.
Policies with similar titles:
Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
Transcutaneous Electrical Nerve Stimulation (TENS) for the Treatment of Nausea and Vomiting
MEDICAL APPROPRIATENESS
Interferential current stimulation is considered medically appropriate when ANY ONE of the following criteria are met:
Pain is ineffectively controlled due to diminished effectiveness of medications
Pain is ineffectively controlled with medications due to side effects
History of substance abuse
Significant pain from postoperative or acute conditions limits the ability to perform exercise programs/ physical therapy treatment
Unresponsive to conservative measures (e.g., repositioning, heat/ice, etc.)
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
The FDA has issued the contraindication that powered muscle stimulators should not be used on individuals with cardiac demand pacemakers.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (11:2010). Interferential stimulation (1.01.24). Retrieved February 8, 2011 from BlueWeb. (10 articles and/or guidelines reviewed)
BlueCross BlueShield of Tennessee network physicians. June-July 2011.
Chour, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., et al. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annuals of Internal Medicine, 147 (7) 478-491.
Fuentes, J. P., Armijo Olivo, S., Magee, D. J. et al. Effectiveness of interferential current therapy in the management of musculoskeletal pain: A systematic review and meta-analysis. Physical Therapy, 90 (9), 1219-1238.
Hayes. Medical Technology Directory. (2008, April; last update search April 2010). Inferential therapy for pain and bone fractures. Retrieved February 8, 2011 from www.hayesinc.com/subscribers. (32 articles and/or guidelines reviewed)
National Guideline Clearinghouse. American College of Occupational and Environmental Medicine. Chronic pain. Retrieved February 17, 2011 from http://www.guidelines.gov/content.aspx?id=14284&search=american+college+of+occupational+and+environmental+medicine.+chronic+pain.
ORIGINAL EFFECTIVE DATE: 3/1/2000
MOST RECENT REVIEW DATE: 7/7/2011
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.