Neuromuscular and Peroneal Nerve Electrical Stimulation (NMES)

This policy covers neuromuscular electrical stimulation (NMES), including functional electrical stimulation (FES) and peroneal nerve stimulators, as part of comprehensive rehabilitation for indications such as disuse atrophy with intact nerve supply, soft‑tissue contractures, selected post‑operative cases (e.g., major knee surgery, recent hip replacement), and for ambulation/foot‑drop in carefully selected incomplete spinal cord injury patients. Coverage requires intact lower motor units (L1 and below), adequate muscle/joint stability and balance, sufficient hand function and patient motivation, supervised one‑on‑one training (typically ≥32 PT sessions over 3 months and appropriate post‑SCI timing), and excludes use over pacemakers, severe scoliosis/osteoporosis, skin cancer at the stimulation site, irreversible contractures or autonomic dysreflexia, lower motor neuron lesions, and other non‑listed indications (e.g., CP, MS, TBI, stroke).

"NMES is medically necessary when used as one component of a comprehensive rehabilitation program for treatment of disuse atrophy when the nerve supply to the atrophied muscle is intact."