Highmark Commercial Medical Policy in West Virginia

Section:	Durable Medical Equipment
Number:	E-16
Topic:	Cranial Electrical Stimulators
Effective Date:	August 8, 2011
Issued Date:	August 8, 2011
Date Last Reviewed:	02/2011

General Policy Guidelines

Indications and Limitations of Coverage

Cranial electrical stimulation (CES) is experimental/investigational. Review of available literature reveals a lack of controlled clinical trials that prove the effectiveness of the procedure. As such, CES devices (E1399) used in the home and clinical setting are also experimental/investigational. A participating, preferred, or network provider can bill the member for the denied service.

Description

A cranial electrical stimulator (E1399) (e.g., Alpha-Stim SCS) is a small, battery-operated device that delivers low level electrical stimulation (i.e., microcurrent) to the brain through electrodes that attach to the ear lobes via clips. Treatment time generally ranges from 20-60 minutes daily, or as directed by the patient’s physician. Its proposed indications include, but may not be limited to, anxiety, depression, insomnia, fibromyalgia, Alzheimer’s Disease, and pain-related disorders.

Cranial electrical stimulation may also be known as cranial electrotherapy stimulation, transcranial electrotherapy, transcranial electrical stimulation, and electrosleep.

NOTE:: This therapy is not to be confused with transcranial magnetic stimulation (TMS) or vagus nerve stimulation (VNS).

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.

Procedure Codes

E1399

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

Provider News

04/2011, Cranial electrical stimulators considered investigational

References

CMS Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Section 240.4, Electrosleep Therapy

Cork RC, Wood P, Ming N, Shepherd C, Eddy J, Price L. The Effect of Cranial Electrotherapy Stimulation (CES) on Pain Associated with Fibromyalgia. The Internet Journal of Anesthesiology. 2004.Volume 8 Number 2. Accessed 2/8/2011.

Tan G, Rintala DH, Thornby JI, Yang J, Wade W, Vasilev C. Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury. J Rehabil Res Dev. 2006 Jul-Aug;43(4):461-74.

Rose KM, Taylor AG, Bourguignon C, et al. Cranial electrical stimulation: Potential use in reducing sleep and mood disturbances in persons with dementia and their family caregivers. Fam Community Health. 2008 Jul-Sep;31(3):240-246.

Rose KM, Taylor AG, Bourguignon C. Effects of cranial electrical stimulation on sleep disturbances, depressive symptoms, and caregiving appraisal in spousal caregivers of persons with Alzheimer's disease. Appl Nurs Res. 2009 May;22(2):119-125.

Rintala DH, Tan G, Willson P, et al. Feasibility of Using Cranial Electrotherapy Stimulation for Pain in Persons with Parkinson's Disease. Parkinson's Disease. Volume 2010 (2010), Article ID 569154, 8. Accessed 2/10/2011. http://downloads.sage-hindawi.com/journals/pd/2010/569154.pdf

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Glossary

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.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Highmark West Virginia plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Highmark West Virginia retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark West Virginia. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.