CG-MED-28 Iontophoresis

This policy addresses iontophoresis, a transdermal medication delivery technique using electrical current. It is medically necessary for local anesthesia before venipuncture or dermatologic procedures, and for primary or secondary hyperhidrosis when prescription-strength antiperspirants have failed and the patient has either medical complications/skin maceration with secondary infection or documented significant functional impairment. It is not medically necessary when these criteria are not met and for all other uses, including temporomandibular disorders and drug delivery of NSAIDs or corticosteroids for inflammatory musculoskeletal conditions.

"Iontophoresis is consideredmedically necessaryforanyof the following indications:"

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