Functional Electrical Stimulation and Neuromuscular Electrical Stimulation

Aetna covers FES for ambulation (e.g., Parastep I), NMES for disuse atrophy and certain perioperative uses, diaphragmatic/phrenic pacing for select high‑cervical SCI, and FDA‑approved form‑fitting conductive garments only for specified NMES indications, while FES/NMES is contraindicated in patients with cardiac pacemakers and other listed conditions, garments are investigational for other uses, and >2 hours/day NMES is not medically necessary. Coverage requires strict criteria — for FES: intact lower motor units (L1 and below), weight‑bearing joint stability and upright balance, brisk stimulation‑evoked contraction and sensory perception, cognitive/manual ability and motivation, independent transfer and ≥3‑minute standing, ≥6 months post‑injury/surgery, no degenerative hip/knee or osteoporotic fracture history, completion of ≥32 PT sessions over 3 months, and no listed contraindications (replacement allowed if original met criteria and is out of warranty/unrepairable); diaphragmatic pacing requires C‑3 or above injury, viable phrenic nerves, adequate diaphragm/lung function, and ability to breathe ≥4 continuous hours off a ventilator.