National Coverage Determination (NCD) for …

1 National Coverage Determination (NCD) for neuromuscular electrical Stimulaton (NMES) ( ) [4/9/2013 11:52:04 AM]HomeAbout CMSN ewsroom CenterFAQsArchiveShareHelpEmailPrintMedi careMedicaid/CHIPM edicare-MedicaidCoordinationInsuranceOve rsightInnovationCenterRegulationsandGuid anceResearch,Statistics, Data andSystemsOutreachandEducationLearn about your healthcare options OVERVIEWADVANCEDSEARCHINDEXESREPORTSDOWN LOADSBASKET (0) Contextual Help is OffPage HelpBack to Document ID Search ResultsNational Coverage Determination (NCD) for neuromuscular ElectricalStimulaton (NMES) ( )Select the Print Record , Add to Basket or Email Record buttons to print the record, to add it to your basket or to email the All Collapse AllBack to Top Tracking InformationPublication Number 100-3 Manual Section Number Section Title neuromuscular electrical Stimulaton (NMES)

2 Version Number 2 Effective Date of this Version 10/1/2006 Implementation Date 10/2/2006 Description InformationBenefit Category No Benefit CategoryNote: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or Description NMES involves the use of a device which transmits an electrical impulse to the skin over selected muscle groups by way of electrodes. There are two broadcategories of NMES. One type of device stimulates the muscle when the patient is in a resting state to treat muscle atrophy. The second type is used to enhancefunctional activity of neurologically impaired and Limitations of Coverage Treatment of Muscle AtrophyCoverage of NMES to treat muscle atrophy is limited to the treatment of disuse atrophy where nerve supply to the muscle is intact, including brain, spinal cord andperipheral nerves, and other non-neurological reasons for disuse atrophy.

3 Some examples would be casting or splinting of a limb, contracture due to scarring ofsoft tissue as in burn lesions, and hip replacement surgery (until orthotic training begins). (See of the NCD Manual for an explanation of Coverage ofmedically necessary supplies for the effective use of NMES.)Use for Walking in Patients with Spinal Cord Injury (SCI)The type of NMES that is use to enhance the ability to walk of SCI patients is commonly referred to as functional electrical stimulation (FES). These devices aresurface units that use electrical impulses to activate paralyzed or weak muscles in precise sequence. Coverage for the use of NMES/FES is limited to SCI patientsfor walking, who have completed a training program which consists of at least 32 physical therapy sessions with the device over a period of three months.

4 The trialperiod of physical therapy will enable the physician treating the patient for his or her spinal cord injury to properly evaluate the person's ability to use these devicesfrequently and for the long term. Physical therapy necessary to perform this training must be directly performed by the physical therapist as part of a one-on-oneNational Coverage Determination (NCD) for neuromuscular electrical Stimulaton (NMES) ( ) [4/9/2013 11:52:04 AM]Back to Toptraining goal of physical therapy must be to train SCI patients on the use of NMES/FES devices to achieve walking, not to reverse or retard muscle for NMES/FES for walking will be covered in SCI patients with all of the following characteristics:1. Persons with intact lower motor units (L1 and below) (both muscle and peripheral nerve);2.

5 Persons with muscle and joint stability for weight bearing at upper and lower extremities that can demonstrate balance and control to maintain an upright supportposture independently;3. Persons that demonstrate brisk muscle contraction to NMES and have sensory perception electrical stimulation sufficient for muscle contraction;4. Persons that possess high motivation, commitment and cognitive ability to use such devices for walking;5. Persons that can transfer independently and can demonstrate independent standing tolerance for at least 3 minutes;6. Persons that can demonstrate hand and finger function to manipulate controls;7. Persons with at least 6-month post recovery spinal cord injury and restorative surgery;8. Persons without hip and knee degenerative disease and no history of long bone fracture secondary to osteoporosis; and9.

6 Persons who have demonstrated a willingness to use the device for walking will not be covered in SCI patient with any of the following:1. Persons with cardiac pacemakers;2. Severe scoliosis or severe osteoporosis;3. Skin disease or cancer at area of stimulation;4. Irreversible contracture; or5. Autonomic only settings where therapists with the sufficient skills to provide these services are employed, are inpatient hospitals; outpatient hospitals; comprehensiveoutpatient rehabilitation facilities; and outpatient rehabilitation facilities. The physical therapy necessary to perform this training must be part of a one-on-onetraining therapy after the purchase of the DME would be limited by our general policies in converge of skilled physical Reference (Also reference the Medicare Benefit Policy Manual, Chapter 15, "Covered Medical and Other Health Services," 220 and 230, and Medicare Claims ProcessingManual, Chapter 5, "Part B Outpatient Rehabilitation and CORF Services," )Claims Processing Instructions TN 941 (Medicare Claims Processing) Back to Top Transmittal InformationRevision History06/1988 - Added cross-reference to section 45-25.

7 Effective date 04/14/1988. (TN 26)11/2002 - Provided Coverage for walking, and maintained noncoverage for treatment of disuse atrophy in SCI patients. Effective and implementation dates04/01/2003. (TN 160 ) (CR 2314) 05/2006 - Added cross-reference to section 220. Effective date 10/01/2006. (TN 55 ) (CR4014)Transmittal Number 55 Coverage Transmittal Link National Coverage Analyses (NCAs) National Coverage Analyses (NCAs) This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from theNational Coverage Analyses reconsideration for neuromuscular electrical Stimulation (NMES) for Spinal Cord Injury (CAG-00153R) National Coverage Determination (NCD) for neuromuscular electrical Stimulaton (NMES) ( ) [4/9/2013 11:52.]

8 04 AM]HomeA federal government website managed by the Centers for Medicare & Medicaid Services7500 Security Boulevard, Baltimore, MD 21244 CMS & HHS LinksWeb Policies & Important LinksPrivacy PolicyPlain LanguageFreedom of Information ActNo Fear with file formats & plug-insReceive Email Updates Back to TopBack to Top Additional InformationOther Versions neuromuscular electrical Stimulaton (NMES) - Version 1, Effective between 4/1/2003 - 10/1/2006 Get Help with File Formats and Plug-Ins Submit Feedback4 Local Coverage Article for neuromuscular electrical Stimulation (NMES) CIM *1&KeyWordLookUp=Doc&KeyWordSearchType=A nd&bc=AAAAABAAAAAAAA%3d%3d&[4/9/2013 11:46:18 AM]HomeAbout CMSN ewsroom CenterFAQsArchiveShareHelpEmailPrintMedi careMedicaid/CHIPM edicare-MedicaidCoordinationInsuranceOve rsightInnovationCenterRegulationsandGuid anceResearch,Statistics, Data andSystemsOutreachandEducationLearn about your healthcare options OVERVIEWADVANCEDSEARCHINDEXESREPORTSDOWN LOADSBASKET (0) Contextual Help is OffPage HelpBack to Search ResultsLocal Coverage Article for neuromuscular electrical Stimulation (NMES) CIMR evision (A5546)

9 Select the Print Record , Add to Basket or Email Record buttons to print the record, to add it to your basket or to email the to TopSection Navigation Select Section Expand All Collapse All Contractor InformationContractor NameNoridian Administrative ServicesContractor Number19003 Contractor TypeDME MAC Article InformationGeneral InformationArticle ID Number A5546 Article Type Article Key Article No Article Title neuromuscular electrical Stimulation (NMES) CIM Revision Primary Geographic Jurisdiction AlaskaAmerican SamoaArizonaCalifornia - Entire StateGuamHawaiiIowaIdahoKansasMissouri - Entire StateMontanaNorth DakotaNebraskaNevadaOregonSouth DakotaUtahWashingtonWyomingNorthern Mariana IslandsDME Region Article Covers Jurisdiction D Original Article Effective Date Local Coverage Article for neuromuscular electrical Stimulation (NMES) CIM *1&KeyWordLookUp=Doc&KeyWordSearchType=A nd&bc=AAAAABAAAAAAAA%3d%3d&[4/9/2013 11:46.]

10 18 AM]Back to TopBack to TopBack to TopRead the Article DisclaimerBack to TopArticle Text11/13/2002 Article Revision Effective Date 03/01/2006 Coverage Issues Manual (CIM), Section 35-77, neuromuscular electrical Stimulation (NMES), is revised to add a new section - Use for Walking in Patients with SpinalCord Injury (SCI). There are two broad categories of NMES. One type stimulates the muscle when the patient is in a resting state to treat patients with muscle second type is used to enhance functional activity in neurologically impaired patients. These devices use electrical impulses to activate paralyzed or weak muscles inprecise sequence and have been utilized to provide the SCI patients with the ability to walk. Based on the evidence they have reviewed, CMS has issued a positivenational Coverage Determination for the use of NMES for walking, but is maintaining the existing National noncoverage policy for the treatment of disuse atrophy in revision is a National Coverage decision (NCD).