Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers TENS per InterQual criteria, FES only as part of comprehensive ambulation rehabilitation for lower‑limb paralysis from spinal cord injury when all listed clinical criteria are met, and NMES for disuse muscle atrophy with intact nerve supply, as part of post‑TKA rehabilitation, and to improve upper‑extremity function post‑stroke; numerous other modalities (e.g., IFT/IFC, MENS, PENS/PNT, PENFS, most PNS/field stimulations, PES, restorative neurostimulation, scrambler therapy, translingual stimulation) are considered unproven and not medically necessary. Coverage requires medical-record documentation meeting the enumerated clinical criteria (e.g., intact lower motor units, weight‑bearing stability, brisk contraction, sensory perception, independent standing/transfer and control manipulation for FES; intact nerve supply and non‑neurological cause for NMES), adherence to InterQual for TENS, and appropriate device/PDAC coding where applicable.