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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