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Archival of policy regarding electrical stimulation and electromagnetic stimulation for the treatment of wounds

February 19, 2020

Effective April 1, 2020, commercial Medical Policy #07.07.07g: Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds will be archived.

Reason for policy archival

Independence is archiving this policy due to minimal reported utilization. Upon archival of this medical policy, the following Healthcare Common Procedure Coding System (HCPCS) codes will be included in Medical Policy #12.01.01aw: Experimental/Investigational Services:

Service type Procedure code

Electrical stimulation (unattended) to one or more areas, for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care.

G0281

Electromagnetic therapy to one or more areas for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.

G0329

Electrical stimulation (unattended) to one or more areas, for wound care other than described in G0281.

G0282

Electromagnetic stimulation to one or more areas, for wound care other than described in G0329 or for other uses.

G0295

Note: Effective April 1, 2020, the coverage position for HCPCS codes G0281 and G0329 will change from medically necessary to experimental/investigational. The coverage position for HCPCS codes G0282 and G0295 will change from not medically necessary to experimental/investigational.

Learn more

Advance notification of archival was posted on the Medical Policy Portal on December 30, 2019. To view this Notification, visit the Medical Policy Portal

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