Non-Invasive Surface Electrical Stimulation for Pain and Rehabilitation 1.01.61
Summary
Excellus policy 1.01.61 is a new policy with an effective date of 05/21/26, derived from policy 1.01.55, and it sets medical necessity criteria for TENS devices, including FDA approval, use for pain, symptoms lasting more than three months, failure of physical therapy, osteopathic manipulative therapy or chiropractic therapy, failure of medications, and a 30-day trial that has demonstrated efficacy. TENS is considered not medically necessary for labor and vaginal delivery pain, headaches and migraines, visceral abdominal pain, TMJ disorder, cancer pain, essential tremor, low back pain and neck pain. The policy also covers NMES for disuse muscle atrophy under listed criteria, considers FES for ambulation in spinal cord injury, stroke rehabilitation and gait training not medically necessary, and considers interferential stimulation, transcutaneous electrical joint stimulation for arthritis joint pain, and multiple modality delivery stimulation investigational.
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