E0744 — Neuromuscular stimulator for scoliosis
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage but does not guarantee coverage of the service requested; refer to the protocol titled Medical Records Documentation Used for Reviews. For FES for lower limb paralysis due to SCI, documentation should demonstrate each of the listed required criteria (exact wording):
- Demonstration of intact lower motor units (L1 and below) (both muscle and peripheral nerves)
- Muscle and joint stability for weight bearing at upper and lower extremities that can demonstrate balance and control to maintain an upright support posture independently
- Demonstration of brisk muscle contraction
Key Coverage Criteria
- Transcutaneous electrical nerve stimulator (TENS) is proven and medically necessary in certain circumstances. For medical necessity clinical coverage criteria, refer to the InterQual® CP: Durable Medical Equipment, Transcutaneous Electrical Nerve Stimulation (TENS). [...]
- Aetna considers the following types of braces and casts medically necessary durable medical equipment (DME) for the treatment of scoliosis: Standard thoracolumbosacral orthosis (TLSO).
- 22548 (listed in the table — appears under covered codes)
- Aetna considers surgery (e.g., spinal fusion with instrumentation and bone grafting) for the treatment of idiopathic scoliosis medically necessary for any of the following conditions: Idiopathic scoliosis with curve greater than or equal to 40 degrees in an adolescent younger than age 18;
- Aetna considers surgery (e.g., spinal fusion with instrumentation and bone grafting) for the treatment of idiopathic scoliosis medically necessary for any of the following conditions: Idiopathic scoliosis with curve greater than or equal to 50 degrees in a young adult age 18 to 25.
- Aetna considers growing rods technique medically necessary in the treatment of idiopathic scoliosis for persons who meet criteria for surgery above (includes the MAGEC System).
12 Active Policies
AMBETTER-CP.MP.48 — Neuromuscular and Peroneal Nerve Electrical Stimulation (NMES)
CIGNA-0160-FUTURE — Electrical Stimulation Therapy and Devices in a Home Setting - (0160)
CIGNA-0160 — Electrical Stimulation Therapy and Devices in a Home Setting - (0160)
UHC-POL-electrical-stimulation-treatment-pain-muscle-rehabilitation — Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
Related Codes
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