CG-MED-100 Surface Electrical Stimulation Devices for Headache and Migraine

Anthem CG-MED-100 addresses surface electrical stimulation devices for headache and migraine, specifically the Nerivio remote electrical neuromodulation (REN) device. Initial Nerivio use is medically necessary for individuals age 8 or older with a 6-month history of migraine meeting ICHD-3 criteria, when used either for acute treatment or for prevention in patients with 6 to 24 headache days per 28-day period in each of the 3 months before starting therapy; all other uses or failure to meet these criteria are not covered. Other surface electrical stimulation devices (e.g., Cefaly, non-implantable transcutaneous vagus nerve stimulation devices such as gammaCore-S) are considered not medically necessary for prevention or treatment of headache/migraine.

"Initial use of the Nerivio®remote electrical neuromodulation (REN) device for the treatment of migraine is consideredmedically necessaryin individuals who meet ALL of the following criteria:"