DME.00011 Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices

This policy addresses surface and percutaneous electrical stimulation modalities for pain and other conditions, specifically auricular electrostimulation, bimodal (acoustic plus peripheral nerve electrical) neuromodulation, and cranial electrical stimulation. Anthem deems these techniques investigational/experimental and not medically necessary for all indications; therefore, they are not covered. Noncoverage applies regardless of diagnosis or care setting and may affect claims billed under codes 64999, A4540, A4543, A4544, A4596, E0721, E0732, E0743, E0761, E0762, E0765, E0769, E1399, K1002, and K1023.

"Note: For examples of devices, see Types of Devices Used for Treatment in the Background/Overview section below."

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