Functional Electrical Stimulators (Non-Pain) - Medicare Advantage

This policy covers functional and neuromuscular electrical stimulators (FES/NMES) and related neuromodulation systems (A4593/A4594), including external stimulators and certain implantable devices (eg, phrenic/diaphragm pacing and implantable transvenous phrenic stimulators) used for non‑pain therapeutic and functional rehabilitation. Indications include paralysis/weakness from spinal cord injury, stroke or brain injury, immobilized extremities post‑injury or surgery, ventilatory insufficiency when phrenic/diaphragm function is adequate, and select neurologic deficits (eg, MS gait), but use is limited to non‑pain purposes, often must be adjunctive to focused rehabilitation, is contraindicated in uncontrolled autonomic dysreflexia, may require pre‑implant motor point mapping, adherence to relevant NCDs/IOMs, and some devices are limited to adults with evidence described as uncertain.

"Partial or complete paralysis may occur when the brain and spinal cord are damaged by injury, stroke or acute disease."