BlueCross BlueShield of Tennessee Medical Policy Manual

Cranial Electrotherapy Stimulation


Cranial electrotherapy stimulation (CES), also referred to as cranial electrical stimulation, transcranial electrical stimulation, or electrical stimulation therapy, is a noninvasive procedure being evaluated as a treatment for a variety of conditions, including pain, insomnia, depression, anxiety, mood disorders and weight loss. Low levels of direct electrical current are applied via electrodes clipped to the ear lobes, mastoid processes or scalp (e.g., Elexoma™ Medic, CES Ultra™, Alpha-Stim®).

The mechanism of action is thought to be the modulation of activity in brain networks by direct action in the hypothalamus, limbic system, and/or the reticular activating system. This device can be used in the home setting. Treatments may last several hours and can be administered once or twice daily for a period of several days to several weeks.




Randomized controlled trials have not consistently demonstrated an improvement in health outcomes. The evidence is insufficient to determine the effects of the technology on health outcomes.


Barclay, T. & Barclay, R. (2014). A clinical trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders, 164, 171-177. Abstract retrieved October 20, 2017 from PubMed database.

BlueCross BlueShield Association. Evidence Positioning System. (3:2019). Cranial electrotherapy stimulation and auricular electrostimulation (8.01.58). Retrieved September 6, 2019 from (20 articles and/or guidelines reviewed)

Gong, B., Ma, H., Zang, X., Wang, S., Zhang, Y., Jiang, N., et al. (2016). Efficacy of cranial electrotherapy stimulation combined with biofeedback therapy in patients with functional constipation. Journal of Neurogastroenterology and Motility, 22 (3), 497-508. (Level 2 evidence)

U.S. Food and Drug Administration. (2007, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database, K062284. Retrieved October 20, 2017 from

Winifred S. Hayes, Inc. Medical Technology Directory. (2017, December; last update search November 2018). Transcranial Direct Current Stimulation for Depression. Retrieved September 6, 2019 from


MOST RECENT REVIEW DATE:  10/10/2019    


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