Electrical stimulation for the treatment of wounds is the application of electrical current through electrodes placed directly on the skin in close proximity to the wound.

Electromagnetic therapy uses a pulsed magnetic field to induce current.

The use of electrical stimulation (G0281) and electromagnetic therapy (G0329) for the treatment of wounds are considered adjunctive therapies, and will only be covered for the following types of wounds:

• Chronic pressure ulcers (Stage III or Stage IV)
• Arterial ulcers
• Diabetic ulcers
• Venous stasis ulcers.

Chronic ulcers are defined as ulcers that have not healed within 30 days of occurrence. Electrical stimulation or electromagnetic therapy will be covered only after appropriate standard wound therapy has been tried for at least 30 days and there are no measurable signs of improved healing. This 30-day period may begin while the wound is acute.

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), offloading 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.

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. ES or electromagnetic therapy must be discontinued when the wound demonstrates 100% epithelialized wound bed.

Electrical stimulation and electromagnetic therapy services 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. Therefore, when codes G0281 or G0329 are reported with 97002 or 97004, the services are combined under procedure code G0281 or G0329, as appropriate. Modifier 59 may be reported with the therapy evaluation, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines.

When a physician, physical therapist, or a clinician incident to a physician, performs electrical stimulation or electromagnetic therapy, the practitioner must evaluate the wound and contact the treating physician if the wound worsens. If electrical stimulation or electromagnetic therapy is being used, wounds must be evaluated at least monthly by the treating physician. 

Only one covered ES therapy or one covered electromagnetic therapy for the treatment of wounds is eligible. 

All other uses of ES and electromagnetic therapy not otherwise specified, as well as home use of the therapy device, will be denied as not medically necessary. A provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement, in the form of a Pre-Service Denial Notice, should be maintained in the provider's records.

Reasons for Noncoverage

Electrical stimulation and electromagnetic therapy will not be covered as an initial treatment modality.

Continued treatment with ES or electromagnetic therapy is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment.

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

Unsupervised home use of electrical stimulation or electromagnetic therapy, is not medically necessary.  Therefore, payment will not be made for a device used to provide electrical stimulation or electromagnetic wound treatment, code E0769.

Documentation Requirements

Evidence that the ulcer has been treated conservatively with standard wound care without improvement for at least 30 days should be documented in the medical record.

Wound assessment should be documented for each reported date of service.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.

Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.

CMS On-Line Manual 100-3, Section 270.1

CMS On-Line Manual 100-04, Chapter 32, Section10.1, 10.2

Covered Diagnosis Codes