Payment may be made for an interferential stimulator (e.g., RS-4i, RS-4M, IF-II, INF Plus, Alpha Stim, Medstar 100)(E1399) when prescribed by a physician for use in the home for the following:

• symptomatic relief and management of chronic pain ; or
• reduction of edema; or
• improvement in range of motion. 

Conditions other than those listed above will be denied as not medically necessary. Effective January 26, 2009, a participating, preferred or network 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 should be maintained in the provider's records.

Use code E1399 to report an interferential stimulator for home use. When you report code E1399, please include the term "interferential stimulator" in the narrative section of the electronic or paper claim.

NOTE:

When performed in a clinical setting, interferential therapy (IFT) is eligible for reimbursement under code 97014.

Coverage is subject to any applicable physical medicine and/or durable medical equipment (DME) limitation in the member's benefit contract.

Refer to Medical Policy Bulletin Z-7 for additional information on electrical nerve stimulation.

Description

Interferential stimulation is a type of electrical nerve stimulation that uses paired electrodes of two independent circuits carrying medium-frequency alternating currents. The electrodes are aligned on the skin so that the current flowing between each pair intersects at the underlying target. This maximizes the current permeating the tissues while minimizing unwanted stimulation of cutaneous nerves. Interferential stimulation has been established as a technique to reduce pain, improve range of motion, or promote local healing following various tissue injuries.

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.

The effects of home interferential therapy on post-operative pain, edema, and range of motion of the knee, Jarit GJ, Clin J Sport Med, 01-JAN-2003; 13(1): 16-20