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Remote Electrical Neuromodulation for Migraines
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Blue Cross & Blue Shield of Mississippi considers remote electrical neuromodulation (REN, such as Nerivio) medically necessary for the prevention of migraine when the listed criteria are met. Remote electrical neuromodulation for acute migraine is considered investigational. For individuals 8 to 17 years of age, the policy states that REN for migraine prevention may be considered medically necessary when the listed criteria are met.
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What to do
Action · 8 steps
01Billing team: bill A4540 (distal transcutaneous electrical nerve stimulator that stimulates peripheral nerves of the upper arm) only for REN used to prevent migraine when the criteria are met, since the code is medically necessary only when the procedure is performed according to the policy section.
02Billing team: for individuals 18 years of age or older, confirm the headaches meet ICHD-3 diagnostic criteria for migraine with or without aura, that the individual had 6 to 24 headache days (a calendar day with headache regardless of severity or duration) per 28-day period in each of the 3 months preceding REN use, and that one additional criterion is documented: insufficient response, contraindication or intolerance to 2 or more guideline-recommended preventive headache medications; pregnancy, breastfeeding or planning to conceive; a risk for or history of medication overuse headache; or a risk for drug-drug interactions with medications for comorbid conditions.
03Billing team: for individuals 8 to 17 years of age, the same ICHD-3 migraine criteria and the same 6 to 24 headache day requirement apply.
04Billing team: acute treatment with REN is considered investigational.
05Billing team: REN is contraindicated in uncontrolled epilepsy and in individuals with an active implantable medical device such as a pacemaker, hearing aid implant or any implanted electronic device.
06Billing team: for continuation of use, document compliance with ongoing use and documentation of clinical benefit, which may include a clinician attestation of pain relief or freedom, reduction in headache frequency, duration or severity, reduction in functional disability, reduction in absenteeism, or reduction in concomitant headache medications.
07Assessment for clinical benefit is reasonable after a minimum of 8 to 12 weeks for preventive treatment.
08Billing team: BCBSMS may request medical records, and letters of support are not sufficient documentation unless all specific information needed for a medical necessity determination is included.
Codes mentioned
A4540G43.701G43.719
Original notice
Remote Electrical Neuromodulation for Migraines
bcbsms.com · Always check the source before changing claims.