DESCRIPTION
Electrical stimulation and electromagnetic therapy are technologies proposed to promote wound healing by increasing or accelerating the biological activities involved in wound healing, including migration of neutrophils and macrophages, stimulation of fibroblasts, and improved blood flow.
Electrical stimulation involves the application of electrical current through electrodes applied directly to the skin near the target wound. The types of electrical stimulation devices can be categorized into groups based on the type of current. This includes low intensity direct current (LIDC), high voltage pulsed current (HVPC), alternating current (AC), and transcutaneous electrical nerve stimulation (TENS).
Electromagnetic therapy is a related but distinct form of treatment that involves the application of electromagnetic fields rather than direct electrical current.
POLICY
Electrical stimulation using low-intensity direct current (LIDC), high-voltage pulsed current (HVPC), alternating current (AC), or transcutaneous electrical nerve stimulation (TENS) for the treatment of wounds in any setting is considered investigational.
Electromagnetic therapy for the treatment of wounds is considered investigational.
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g., statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the medical policy and a health plan or government program (e.g., TennCare), the express terms of the health plan or government program will govern.
ADDITIONAL INFORMATION
No electrical stimulation or electromagnetic therapy devices have received approval from the U. S. Food and Drug Administration (FDA) specifically for the treatment of wounds.
SOURCES
American College of Physicians. (2015). Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Retrieved October 18, 2016 from http://annals.org.
Arora, M., Harvey, L.A., Glinsky, J.V., Nier, L., Lavrencic, L., Kifley, A., et al. (2020). Electrical stimulation for treating pressure ulcers. Cochrane Database Syst Rev, 1 (1), CD012196, doi: 10.1002/14651858.CD012196.pub2. (Level 1 evidence)
Association for the Advancement of Wound Care. (2010). Pressure ulcer guidelines. Retrieved November 17, 2015 from http://aawconline.org.
Barnes, R., Shahin, Y., Gohil, R., & Chetter, I. (2014). Electrical stimulation vs. standard care for chronic ulcer healing: a systematic review and meta-analysis of randomized controlled trials. European Journal of Clinical Investigation, 44 (4), 429-440. Abstract retrieved October 18, 2016 from PubMed database.
BlueCross BlueShield Association. Evidence Positioning System. (2:2024). Electrostimulation and electromagnetic therapy for treating wounds (2.01.57). Retrieved April 12, 2024 from www.bcbsaoca.com/eps/. (20 articles and/or guidelines reviewed)
Center for Medicare and Medicaid Services. CMS.gov. NCD for electrical stimulation and electromagnetic therapy for the treatment of wounds (270.1) Retrieved October 18, 2016 from https://www.cms.gov.
International Consolidated Venous Ulcer Guideline. (2015). Update of AAWC Venous Ulcer Guideline, 2005 and 2010. Retrieved August 25, 2017 from http://aawconline.org.
Khouri, C., Kotzki, S., Roustit, M., Blaise, S., Gueyffier, F., & Cracowski, J.L. (2017). Hierarchical evaluation of electrical stimulation protocols for chronic wound healing: an effect size meta-analysis. Wound Repair and Regeneration, 25 (5), 883-891. Abstract retrieved August 27, 2019 from PubMed database.
Lala, D., Spauling, S.J., Burke, S.M., & Houghton, P.E. (2016). Electrical stimulation therapy for the treatment of pressure ulcers in individuals with spinal cord injury: a systematic review and meta-analysis. International Wound Journal, 13 (6), 1214-1226. (Level 2 evidence)
Miller, C., McGuiness, W., Wilson, S., Cooper, K., Swanson, T., Rooney, D., et al. (2017). Venous leg ulcer healing with electric stimulation therapy: a pilot randomised controlled trial. Journal of Wound Care, 26 (3), 88-98. Abstract retrieved August 25, 2017 from PubMed database.
Polak, A., Kloth, L.C., Blaszczak, E., Taradaj, J., Nawrat-Szoltysik, A., Ickowicz, T., et al. (2017). The efficacy of pressure ulcer treatment with cathodal and cathodal-anodal high-voltage monophasic pulsed current: a prospective, randomized, controlled clinical trial. Physical Therapy, 97 (8), 777-789. Abstract retrieved August 27, 2019 from PubMed database.
ORIGINAL EFFECTIVE DATE: 4/1/2003
MOST RECENT REVIEW DATE: 5/9/2024
ID_BA
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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