Electric Stimulation for Pain, Swelling and Function in a Clinic Setting - (CPG272)

Cigna covers clinic-based electric stimulation (e.g., TENS/EMS) short-term (up to 2 weeks) when prescribed as part of a comprehensive treatment under direct physical‑therapy supervision and covers NMES only for disuse atrophy when the nerve is intact and used with active exercise for non‑neurological causes (e.g., failure to respond after major hip/knee surgery or prior immobilization), while numerous devices/modalities (e.g., H‑WAVE®, MENS, PENS/PNT, TEMPR/Scrambler, Neufit, many pelvic floor devices, etc.) are considered experimental/investigational and excluded. Key requirements: treatment must be in an outpatient clinic with direct PT supervision, documented clinical response and specific stimulation parameters, evidence nerve integrity/failed prior therapy for NMES, adherence to short‑term limits, and billing with the appropriate CPT/HCPCS codes when policy criteria are met.

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