External Upper Limb Tremor Stimulator Therapy - Policy Article

External upper limb tremor stimulators (E0734) and related supplies (A4542) are covered as DME for beneficiaries age >=18 with essential tremor affecting the dominant upper limb when severe impairment of upper-limb ADLs is documented (BF-ADL >=3) and at least two pharmacologic treatments have failed or been ruled out. Coverage requires adherence to LCD reasonable-and-necessary criteria, documentation of a face-to-face encounter and a Written Order Prior to Delivery (WOPD) where applicable, correct use of modifiers (KX when criteria met; GA/GZ when not), and limb-specific billing with RT/LT modifiers; accessory A4542 may be rebilled every 90 days.

"Beneficiary is age >= 18 with a diagnosis of essential tremor (ET) affecting their dominant upper limb and has no contraindications to external upper limb tremor stimulator therapy."

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