CommercialCoverageMedium impact
Electrical Stimulation as a Treatment for Pain and Other Medical Conditions 1.01.55
Excellus BlueCross BlueShield·Pain Management, PM&R (Physical Medicine & Rehab), Physical Therapy +2 more·Durable Medical Equipment & Supplies
Effective date
Nov 20, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their electrical stimulation policy, establishing strict criteria for TENS device coverage requiring 3+ months of pain, failed conservative treatments, and 30-day trial efficacy. The policy also clarifies that many electrical stimulation modalities including functional electrical stimulation and peripheral nerve stimulation are considered investigational and not covered.
Action Required
Before November 20, 2025: Billing team must update prior authorization requirements for TENS devices to verify patients meet ALL criteria: FDA approval, pain >3 months, failed PT/chiropractic/medications, and documented 30-day trial efficacy. Flag that low back pain, neck pain, headaches, TMJ, and cancer pain are excluded. For PENS/PNT procedures, use only CPT 64999 (unlisted code) - do not use CPT 64553-64561 or 64590. Update system to flag all investigational electrical stimulation devices listed in section VII for coverage denial.