Electrical Stimulation for the Treatment of Wounds

Electrical stimulation (ES) has been used or studied for many different applications, one of which is accelerating wound healing. ES for the treatment of wounds is the application of electrical current through electrodes placed directly on the skin in close proximity to the wound. ES for the treatment of wounds will only be covered for chronic Stage III or Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers. All other uses of electrical stimulation for the treatment of wounds are noncovered. Chronic ulcers are defined as ulcers that have not healed within 30 days of occurrence. ES will not be covered as an initial treatment modality.

The use of electrical stimulation for the treatment of wounds is considered an adjunctive therapy. Electrical stimulation will be covered only after appropriate standard wound therapy has been tried for at least 30-days and there are no measurable signs of healing. This 30-day period can begin while the wound is acute. Measurable signs of improved healing include a decrease in wound size, either surface area or volume, decrease in amount of exudates and decrease in amount of necrotic tissue. Standard wound care includes: optimization of nutritional status; debridement by any means to remove devitalized tissue; maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings; and necessary treatment to resolve any infection that may be present. Standard wound care based on the specific type of wound includes: frequent repositioning of a patient with pressure ulcers (usually every 2 hours); off-loading of pressure and good glucose control for diabetic ulcers; establishment of adequate circulation for arterial ulcers; and the use of a compression system for patients with venous ulcers.

Continued treatment with electrical stimulation is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment. Electrical stimulation must be discontinued when the wound demonstrates 100 per-cent epithelialzed wound bed.

Any form of electromagnetic therapy for the treatment of chronic wounds will not be covered.

This service can only be covered when performed by a physician, physical therapist, or incident to a physician service. Evaluation of the wound is an integral part of wound therapy. When a physician, physical therapist, or a clinician incident to a physician, performs electrical stimulation, that practitioner must evaluate the wound and contact the treating physician if the wound worsens. If electrical stimulation is being used, wounds must be evaluated at least monthly by the treating physician.

Unsupervised use of electrical stimulation for wound therapy will not be covered, as this use has not been found to be medically reasonable and necessary.

04/1997 - Provided noncoverage policy. Effective date 05/14/1997. (TN 95)

05/1997 - Corrected pagination error. Effective date NA. (TN 98)

05/1997 - Changed effective date for TN 95 to 07/14/1997. Effective date 07/14/1997. (TN 100)

12/1997 - Suspended implementation of national coverage policy due to court decision in Aitken v Shalala. As a result of the court’s decision, CMS and its agents ordered to return to case-by-case evaluation regarding necessity and reasonableness of treatments. Includes all claims for services performed after July 14, 1997. (PM B-97-11)

11/2002 - Covered only for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers. Electrical stimulation not covered as an initial treatment modality. Electrical stimulation covered only after standard wound therapy has been tried for at least 30-days and there are no measurable signs of healing. Medicare will not cover any form of electromagnetic therapy for the treatment of chronic wounds. Effective and implementation dates 04/01/2003. (TN 161) (CR 2313)