Neuromuscular Electrical Stimulation
DESCRIPTION
Neuromuscular electrical stimulation (NMES), also known as therapeutic (or threshold) electrical stimulation (TES), is a form of electrical stimulation that attempts to strengthen muscles weakened by disuse. TES uses sub-contraction stimulus to promote muscle growth. In an individual with disuse atrophy, contracting muscles use the strongest fibers; therefore weakened muscles do not respond and deteriorate further. NMES is used at night during sleep, and is purported to increase blood flow to the muscles in which fibers are atrophied. NMES can also be used in the outpatient setting as an adjunct therapy to treat muscle atrophy.
NMES has been used for individuals who have joint mobility problems, such as contractures; circulation inadequacies; disuse atrophy; spasticity (tone abnormalities) and gait abnormalities such as foot drop. NMES has also been used for orthopedic rehabilitation in individuals who have musculoskeletal dysfunction (e.g., disuse weakness, joint restrictions, edema, and spasms). This therapy is used in conjunction with physical and occupational therapies to strengthen muscle tone and improve functional abilities. NMES has also been investigated for the treatment of dysphagia (e.g., VitalStim™), in conjunction with speech pathology services.
Functional neuromuscular stimulation (FNS) and functional electrical stimulation (FES) are essentially interchangeable terms. FNS/FES (e.g., Parastep Ambulation System) attempts to replace stimuli from destroyed nerve pathways with computer-controlled sequential electrical stimulation of muscles. This is done in an effort to enable spinal-cord-injured individuals to grasp, stand or walk independently, or at least maintain healthy muscle tone and strength.
FNS does not refer to commercially available exercycles that use electrical muscle stimulation technology as a means of physical therapy and exercise for individuals with a spinal-cord-injury. These exercycles are sometimes called functional neuromuscular exercisers. The individual's legs are wrapped in fabric strips that contain electrodes to stimulate the muscles, thus permitting the individual to pedal. This is a physical therapy modality.
POLICY
Neuromuscular electrical stimulation (NMES) for the prevention and/or treatment of disuse muscle atrophy following immobilization, injury, or surgery is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Neuromuscular electrical stimulation (NMES) for the treatment of other conditions / diseases, including, but not limited to, the following is considered investigational:
As a muscle-strengthening regimen in healthy individuals
In the treatment of scoliosis
To reduce spasticity or facilitate voluntary motor control in individuals with spinal cord injury, cerebral palsy, or other upper motor neuron disorders
In the treatment of denervated muscles
In the treatment of pain (e.g., HVG unit, Hi-voltage Galvanic Stimulator)
In the treatment of dysphagia
Functional neuromuscular stimulation (FNS) is considered investigational.
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.
MEDICAL APPROPRIATENESS
Neuromuscular electrical stimulation (NMES) is considered medically appropriate if ALL the following criteria are met:
Use of NMES for ANY ONE of the following:
Prevention of disuse muscle atrophy
Treatment of disuse muscle atrophy
The individual meets ALL of the following:
Is at least two years of age and of average size and weight
Has a nerve supply to the muscle that is intact, including brain, spinal cord and peripheral nerves
Shows improvement in muscle function within four weeks from the start of therapy
ADDITIONAL INFORMATION
A compliance monitor is not considered to be a necessary component of a therapeutic electrical stimulator device.
There is a lack of randomized controlled trials providing evidence of the efficacy of neuromuscular electrical stimulation (NMES) for the indications listed as investigational in the above policy and for functional neuromuscular stimulation (FNS). Validation of NMES requires controlled, randomized studies that can isolate the contribution of the electrical stimulation from other components of therapy. FNS devices (e.g., Parastep Ambulation System) are being tried as a mode of short-term ambulation. However, final health outcomes, such as ability to perform activities of daily living or quality of life, have also not been reported.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2009). Functional neuromuscular stimulation to provide ambulation (8.03.01). Retrieved June 11, 2009 from BlueWeb. (18 articles and/or guidelines reviewed)
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2008). Threshold electrical stimulation as a treatment of motor disorders (1.01.19). Retrieved June 11, 2009 from BlueWeb. (7 articles and/or guidelines reviewed)
Burnett, T. A., Mann, E. A., Stoklosa, J. B., & Ludlow, C. L. (2005, August). Self-triggered functional electrical stimulation during swallowing. Journal of Neurophysiology, 94 (6), 4011-4018. Abstract retrieved November 23, 2005 from PubMed database.
Complete Guide to Medicare Coverage Issues [Computer software]. (2009, April). Neuromuscular electrical stimulation (NMES) (NCD 160.12, p. 2-76). The Ingenix Complete Guide to Medicare Coverage Issues.
Hayes. Medical Technology Directory. (2008, June). Neuromuscular electrical stimulation for muscle rehabilitation. Retrieved June 11 2009 from www.Hayesinc.com/subscribers. (39 articles and/or guidelines reviewed)
U. S. Food and Drug Administration. (2001, February). Center for Devices and Radiological Health. Pre-market approval decisions for February 2001. Retrieved October 12, 2005 from http://www.fda.gov/cdrh/510k/sumdec02.html.
ORIGINAL EFFECTIVE DATE: 3/1980
MOST RECENT REVIEW DATE: 7/9/2009
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.
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