DME.00022 Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES)

This policy addresses functional electrical stimulation (FES) and threshold electrical stimulation (TES) for neurologic rehabilitation, including devices such as ERGYS/ERGYS2 FES ergometers, Parastep I, NESS H200, NESS L300, ODFS Dropped Foot Stimulator, and WalkAide. Anthem considers both FES and TES investigational and not medically necessary for all indications; they are not covered when used to prevent/reverse disuse atrophy or bone loss via stationary exercise, correct gait or promote ambulation, activate upper/lower limb muscles for functional movement, or treat motor disorders (e.g., cerebral palsy, post-stroke paralysis). There are no covered indications under this policy, and related claims are subject to non-coverage.

"Functional electrical stimulation (FES) is consideredinvestigational and not medically necessaryfor all indications, including but not limited to:"