K1023, Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- When making coverage determinations, review the member's benefit contract or Summary Plan Description (SPD) for coverage definitions, exclusions, and benefit limitations (e.g., dollar or duration caps).
Key Coverage Criteria
- Use the International Classification of Headache Disorders (ICHD-3) criteria to diagnose migraine (with or without aura).
- REN was prescribed in the CED study to members aged 12–75 with diagnosed migraine. Study eligibility criteria included at least one failed standard-of-care acute migraine therapy (due to contraindication, insufficient efficacy, or intolerability), risk of drug–drug interaction, pregnancy/trying to conceive/breastfeeding, chronic migraine with risk/diagnosed medication overuse headache (MOH), or age younger than 18 years.
- Use the International Classification of Headache Disorders (ICHD-3) criteria to diagnose migraine (with or without aura).
- REN was prescribed in the CED study to members aged 12–75 with diagnosed migraine. Study eligibility criteria included at least one failed standard-of-care acute migraine therapy (due to contraindication, insufficient efficacy, or intolerability), risk of drug–drug interaction, pregnancy/trying to conceive/breastfeeding, chronic migraine with risk/diagnosed medication overuse headache (MOH), or age younger than 18 years.
- Use the International Classification of Headache Disorders (ICHD-3) criteria to diagnose migraine (with or without aura).
- REN was prescribed in the CED study to members aged 12–75 with diagnosed migraine. Study eligibility criteria included at least one failed standard-of-care acute migraine therapy (due to contraindication, insufficient efficacy, or intolerability), risk of drug–drug interaction, pregnancy/trying to conceive/breastfeeding, chronic migraine with risk/diagnosed medication overuse headache (MOH), or age younger than 18 years.
5 Active Policies
ANTHEM-DME.00011, DME.00011 Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices
BCBSIL-SUR701.046, Remote Electrical Neuromodulation for Migraines
BCBSMT-SUR701.046, Remote Electrical Neuromodulation for Migraines
BCBSNM-SUR701.046, Remote Electrical Neuromodulation for Migraines
BCBSOK-SUR701.046, Remote Electrical Neuromodulation for Migraines
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