BlueCross BlueShield of Tennessee Medical Policy Manual

Electrical Stimulation for the Treatment of Arthritis

DESCRIPTION

One form of electrical stimulation is sub-sensory pulsed electrical stimulation. Pulsed electrical stimulation (e.g., BioniCare Bio-1000™) using surface electrodes has been proposed for the treatment of osteoarthritis of the knee and rheumatoid arthritis of the hand to improve functional status and relieve pain related to osteoarthritis and rheumatoid arthritis unresponsive to other standard therapies. In basic research studies, sub-sensory, low-voltage, monophasic pulsed electrical stimulation has been shown to alter chondrocyte-related gene expression in vitro and to have regenerative effects in animal models of cartilage injury. Therefore, pulsed electrical stimulation is proposed to be similar to bone stimulator therapy for fracture nonunion.

This device received the U.S. Food and Drug Administration (FDA) 510(k) marketing clearances to deliver pulsed electrical stimulation for the treatment of osteoarthritis of the knee and rheumatoid arthritis of the hand, after finding it to be substantially equivalent to transcutaneous electrical nerve stimulation (TENS) devices.  However, these systems should not be confused with other stimulators. This system is intended to stimulate the joint tissue to improve the overall health of the joint. This type of system consists of an electronic stimulator device with electrical leads that are placed over the affected area and held in place with a lightweight, flexible wrap and Velcro fasteners. It is recommended that the device be worn for at least 6 hours per day, and patients are reported to often wear the device while sleeping.

POLICY

See also: 

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

No studies were identified for the use of electrical stimulation for rheumatoid arthritis and only a few, small trials were found with regard to the use of electrical stimulation for the treatment of knee osteoarthritis. There is a lack of current evidence to show improved health outcomes in comparison to other available treatments with the use of electrical stimulation for the treatment of arthritis.

 

SOURCES 

BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2011). Electrical Stimulation for the Treatment of Arthritis (1.01.27). Retrieved September 10, 2012 from BlueWeb. (8 articles and/or guidelines reviewed)

Harrington, J. T., Hungerford, D. S., Ford, T. L., Deveshwar, S., Mines, C. M., Sheinkop, M. B. et al. (2011). New options for treating osteoarthritis of the knee. Retrieved September 11, 2012 from http://www.bionicare.com/options-treating-osteoarthritis-knee/.

 

U. S. Food and Drug Administration. (2008, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K073386.  Retrieved September 10, 2012 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K073386.pdf.

 

U. S. Department of Health & Human Services. Centers for Medicare & Medicaid Services. (2009, March). Decision of Medicare Appeals. Retrieved September 11, 2012 from http://www.hhs.gov/dab/divisions/medicareoperations/macdecisions/bionicare.pdf.

ORIGINAL EFFECTIVE DATE:  3/14/2013

MOST RECENT REVIEW DATE: 3/14/2013

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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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