A4596, Cranial electrotherapy stimulation (ces) system supplies and accessories, per
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- The plan of care should be ongoing (i.e., updated as the patient's condition changes), and treatment should demonstrate reasonable expectation of improvement.
- "A reasonable estimate of when the goals will be reached;"
- "Long-term and short-term goals that are specific, quantitative and objective;"
- "Cognitive therapy evaluation;"
Key Coverage Criteria
- ICD-10 G92.00 - G92.9 Toxic encephalopathy (covered if selection criteria are met).
- Rehabilitation for visuo-spatial deficits (generally entails 20 1-hour sessions delivered over the course of 4 weeks).
- Rehabilitation for language and communication deficits (persons usually receive 8 hours of weekly therapy, beginning at 4 weeks post-onset and continuing up to 48 weeks post-onset).
- Cognitive rehabilitation is considered medically necessary for encephalopathy due to HIV when medical necessity criteria in section I above are met.
- ICD-10 F07.81 Postconcussion syndrome (covered if selection criteria are met).
- Cognitive rehabilitation as adjunctive treatment of cognitive deficits (e.g., attention, language, memory, reasoning, executive functions, problem solving, and visual processing) when performed by a licensed health care professional acting within their scope of practice and all of the following are met: Neuropsychological testing has been performed and neuropsychological results will be used in treatment-planning and directing rehabilitation strategies; and The cognitive deficits have been acqui [...]
8 Active Policies
ANTHEM-DME.00011, DME.00011 Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices
AETNA-CPB-0214, Cognitive Rehabilitation
AETNA-CPB-0469, Transcranial Magnetic Stimulation and Cranial Electrical Stimulation
BCBSIL-SUR702.019, Cranial Electrotherapy Stimulation and Auricular Electrostimulation
BCBSMT-SUR702.019, Cranial Electrotherapy Stimulation and Auricular Electrostimulation
Related Codes
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