Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
List also available in PDF format.
See Treatment Guidelines and Resources for additional information.
(Last updated: September 2021)
Neuromuscular electrical stimulation involves the use of transcutaneous application of electrical currents to cause muscle contractions. The purpose is to strengthen and train healthy muscles at risk of atrophy due to immobilization or disuse following injury, or to stimulate denervated muscles to prevent atrophy and degeneration. NMES is not for the purpose of treating chronic pain. It can be administered in both an outpatient and inpatient setting.
Coverage decision: Covered with conditions
Conditions of Coverage
- The device is approved by the FDA specifically as an NMES device.
- It may be used without pre-authorization in a clinical setting as part of a physical therapy treatment plan, according to the policies and rules for physical therapy treatment.
- It may be used in the home setting if all the following criteria are met:
- Only single function NMES devices are covered for home use
- Home use is pre-authorized, and
- It is used for the strengthening and training of muscles and not for the relief of chronic pain and
- The patient has suffered partial or complete loss of function in one or more muscles due to an injured peripheral nerve or nerve root and
- Denervation is substantiated by electromyography (EMG) showing positive waves and/or fibrillation in the affected muscles.
Implementation of the Decision
NMES may be used only for care of a condition accepted on the claim. All requests require prior authorization.
For State Fund Claims
All requests will be reviewed by L&I’s occupational nurse consultant and claims manager.
- Complete the Preauthorization Form and fax to: (360) 902-4567
- For additional information contact the claims manager
- To obtain the claims manager’s phone number call 1-800-831-5227.
- Attending provider, concurrent care provider or IME: log into the Claims & Account Center (CAC).
For information, on physical therapy pre-authorization requirements please see our Physical, Occupational & Massage Therapy site.
For State Fund claims, an L&I medical consultant must review the documentation and confirm that at-home use of NMES is medically necessary. The medical consultant will recommend a time frame for use of the device based upon the injury.