Medical Policy: 01.01.23 

Original Effective Date: November 2000 

Reviewed: July 2020 

Revised: July 2020 



This policy contains information which is clinical in nature. The policy is not medical advice. The information in this policy is used by Wellmark to make determinations whether medical treatment is covered under the terms of a Wellmark member's health benefit plan. Physicians and other health care providers are responsible for medical advice and treatment. If you have specific health care needs, you should consult an appropriate health care professional. If you would like to request an accessible version of this document, please contact customer service at 800-524-9242.


Benefit Application:

Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.


This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.



Neuromuscular electrical stimulation (NMES) involves the use of a device that transmits an electrical impulse to the skin over selected muscle groups by way of electrodes. There are two categories of NMES. One type of device is used to treat muscle atrophy and stimulates the muscle when the individual is in a resting state. The second type, is also known as functional electrical stimulation (FES), which is used to enhance functional activity (e.g., grasping utensils for feeding or ambulation) of neurologically impaired individuals.


Neuromuscular Muscular Electrical Stimulators (NMES) for Muscular Disuse Atrophy

NMES is used as a treatment modality for disuse atrophy due to a condition such as limb casting or hip replacement surgery, where the nerve supply to the muscle is intact. The NMES device encompasses a portable stimulator with electrodes that are placed on the skin over targeted muscle or muscle group. The current passes through the electrodes into the body, and the motor nerves are stimulated, causing a muscle contraction. The intensity and frequency of stimulation can vary based on the level of muscular function and response to treatment.


The use of NMES was studied by the Office of Health Technology Assessment (OHTA) at the Public Health Service in cases where neural supply (including brain, spinal cord, and peripheral nerves) to the muscle was intact or where other non-neurological reasons for disuse were causing atrophy. The report excluded clinical situations where the cause of the disuse was considered permanent or was characterized by a non-reversible pathology. Based upon their complete assessment of all relevant literature, OHTA concluded that the use of NMES for the treatment of disuse atrophy is considered effective therapy when the cause of the muscle disuse is not permanent and there is no nervous system involvement. In this situation, the treatment of disuse atrophy was considered a surrogate health outcome (that is, an intermediate outcome as opposed to an eventual outcome, such as the ability to ambulate), since the treatment of disuse atrophy generally leads to a full recovery of function.


TENS (transcutaneous electric nerve stimulators) versus NMES- TENS and NMES target different nerve groups of the body. TENS is specifically targets the sensory nerves, which are responsible for sending pain signals to the brain. NMES targets the muscle itself, specifically through the motor nerves. This allows the NMES machine to create a muscle contraction to recruit more muscle fibers when training; warming up or recovering. Sensory and motor nerves fire at different frequencies, which is why NMES and TENS devices affect the body differently. TENS is not managed by this current policy.


Functional Electrical Stimulators for the Treatment of Neuromuscular Conditions

The second type of NMES is FES (functional electrical stimulation), which is used to enhance functional activity in neurologically impaired patients. The objective of FES is to activate targeted muscle groups to facilitate performance of functional activities (e.g., grasping utensils for feeding) or movements (e.g., ambulation). The use of FES has primarily been proposed for individuals with neurological conditions such as spinal cord injury (SCI), multiple sclerosis, cerebrovascular accident (CVA), and cerebral palsy (CP).


An application of FES is to provide individuals with a spinal cord injury (SCI) with the ability to stand and walk. The FES device delivers a precise sequence of electrical pulses to trigger action potential at selected nerves at the quadriceps (for knee extension), common peroneal nerve (for hip flexion), and the paraspinals and gluteal (for trunk stability). The individual uses a walker or elbow support crutches for further support. The electrical impulses are controlled by a computer microchip attached to the individual’s belt that synchronizes and distributes the signals. Additionally, there is a finger-controlled switch that permits activation of the stepping by the individual. The Parastep® Ambulation System (Therapeutic Alliances, Inc, Fairborn, OH) is the only device to receive approval by the FDA and is indicated to “enable appropriately selected skeletally mature spinal cord injured patients (C6-T12) to stand and attain limited ambulation and/or management of spinal cord injury.”


How the Parastep System Works

The Parastep® Ambulation System works by delivering microcomputer-controlled electrical pulses through surface (skin) applied electrodes to nerves and muscles, causing muscle contractions. The computer is programmed to control the sequence of muscle contractions in the lower extremities that enable the functions of sit-to-stand, right and left step, and stand-to-sit. Users are taught to initiate functions by activating commands through switch modules mounted on the walker.


The system is designed to provide up to 6 channels of stimulation (i.e. stimulate up to 3 muscle groups on each leg/side). However, some individuals may require only 4 channels of stimulation to stand and ambulate.

  • When 4 channels are used, electrical stimulation is directed to 4 electrodes on each lower extremity:
    • Stimulation of the quadriceps muscles results in knee extension, enabling the use to stand.
    • Stimulation of the peroneal nerve in the lower extremity initiates a triple-flexion reflex response, resulting in contraction of muscles to flex the hip, knee and ankle, which lifts the foot off the floor.
    • Subsequent quadriceps stimulation extends the knee in preparation for heel-strike and weight bearing.
  • When 6 channels of stimulation are used, electrical stimulation is directed to the previously mentioned sites above and to two additional electrodes on the hip.
    • Stimulation of gluteal muscles extends the hips, contributing to stability while standing and taking steps.


The user initiates and controls the intensity of stimulation to the muscles and nerves through the keypad on the stimulator/control unit or through two switch modules mounted on the walker handle bars. The walker provides balance and stability during standing and walking.


Physical therapy is a key component to the Parastep® Ambulation System. Thirty-two sessions of physical therapy including instruction on system use and gait training, are provided to users when they purchase a system. The training is provided by hospital based physical therapists who have completed Sigmedics, Inc.’s clinical training program.


Each user’s progress is carefully monitored with frequent adjustments made in the training program to accommodate each user’s individual requirements. Treatment sessions progress at a pace set by each user’s ability, skill and proficiency.


To acquire a Parastep® Ambulation System an individual must participate in an approved Parastep® clinical training program and obtain a physician's prescription.


Other FES Devices

Other (FES) devices have been developed for individuals with foot drop. Foot drop is caused by weakness in the foot and ankle, which is activated by the peroneal nerve that results in a decreased dorsiflexion and causes difficulty with ambulation. It can be caused by neurological conditions that include spinal cord injury (SCI), multiple sclerosis (MS), cerebrovascular accident (CVA) and cerebral palsy (CP). WalkAide® and the Bioness NESS L300™ (Innovative Neurotronics, Inc., Bethesda, MD) are examples of FES devices for foot drop. The NESS L300™ consists of three components: a functional stimulation cuff is worn by the individual by the individual just below the knee and holds the stimulation device and electrodes. The gait sensor is worn inside the individuals shoe and automatically detects different walking speeds and surface and sends a signal to the functional stimulation cuff to adjust the stimulation to the peroneal nerve to allow the individual’s gait to be adjusted. The control device allows the individual to turn the NESS L300™ on and off, as well as make stimulation adjustments.


There have been small studies that have focused on FES devices for foot drop. However, these studies did not demonstrate that the use of such devices provide a clinically significant improvement in ambulation. A single randomized controlled trial examining FES for foot drop individuals with MS did not demonstrate a clinically significant benefit when compared with no stimulation or a program of exercise. Studies with a larger number of individuals over a longer duration are needed to permit conclusions concerning the safety and effectiveness of this technology on health outcomes in individuals with foot drop (gait disturbances).


The use of FES has been used in an effort to increase muscle strength in children with cerebral palsy (CP). Several randomized trials have failed to show clinically significant improvement in muscle strength or function.


Another application of FES is to restore upper extremity functions such as grasp-release in individuals with CVA or SCI. An example of FES device for the upper extremity is the NESS H200™ (Innovative Neurotronics, Inc., Bethesda, MD). It consists of two components, an orthosis and a control device. The orthosis fits on the individual’s hand and forearm and maintains the wrist in position to perform functional hand movements. It has electrodes that are in direct contact with the individuals forearm muscles. The control device has microprocessor that sends electrical impulses from the control device to the electrodes and stimulates the forearm muscles, causing muscle activation and the ability to pinch, grasp, and release. Based on the peer reviewed literature, the evidence for the use of FES devices for upper extremity function is limited by a small number of subjects and limited data demonstrating its utility outside the clinical setting. The available evidence is insufficient to conclude the safety and effectiveness that FES improves health outcomes of providing upper extremity function.


Microcurrent Electrical Nerve Stimulation (MENS)

MENS involves the use of a device that delivers small amounts of electrical current (millionths of an amp) to help relieve pain and heal soft tissues of the body. The application of microcurrent stimulation to an injured area is proposed to realign the body’s electrical current and increase the production of adenosine triphosphate, resulting in increased healing and recovery and blocking of perceived pain. The electrical current is subsensory and usually not felt.


Transcutaneous electrical modulation pain reprocessing (eg, scrambler therapy, TEMPR therapy)

Transcutaneous electrical modulation pain reprocessing (TEMPR), also called Scrambler therapy or Calmare® pain therapy, delivers electrical stimulation via the nerve fibers to convey a message of normality to the central nervous system (CNS) by a procedure defined as “scrambling” or “tricking” of information. The device is proposed to send a very low current of electrical stimulation through the nerve fibers, which carries a "no pain" signal to the brain that overrides the previous pain signal.


Regulatory Status

The Neurocontrol Freehand system received approval from the U.S. Food and Drug Administration (FDA) in 1997 through the premarket approval (PMA) process. The Handmaster NMS I system was originally cleared for use in maintaining or improving range of motion, reducing muscle spasm, preventing or retarding muscle atrophy, providing muscle re-education, and improving circulation; in 2001, its 510(k) marketing clearance was expanded to include provision of hand active range of motion and function for patients with C5 tetraplegia.


The WalkAide device first received 510(k) marketing clearance from FDA in the 1990s; the current version of the WalkAide device received 510(k) marketing clearance in September 2005. The Odstock Foot Drop Stimulator received 510(k) marketing clearance in 2005. The Bioness NESS L300 received 510(k) marketing clearance in July 2006. FDA summaries for the devices state that they are intended to be used in patients with drop foot by assisting with ankle dorsiflexion during the swing phase of gait.


ARP Wave Neuro Therapy (Accelerated Recovery Performance) treatments work on the principle that joint problems, tendonitis, tears, sprains, fractures, or repetitive task injuries are caused by muscles not properly absorbing force. This energy is transferred to tissue not intended to accept the force.


To date, the Parastep® Ambulation System is the only noninvasive functional walking neuromuscular stimulation device to receive PMA from FDA. The Parastep device is approved to "enable appropriately selected skeletally mature spinal cord injured patients (level C6-T12) to stand and attain limited ambulation and/or take steps, with assistance if required, following a prescribed period of physical therapy training in conjunction with rehabilitation management of spinal cord injury."


MyndMove™ is a functional electrical stimulation (FES) device intended to improve voluntary hand and arm movement in patients with paralysis after a stroke or spinal cord injury. The system comprises an eight-channel electrical stimulator, a touch-screen interface, and embedded stimulation protocols. Electrical stimulation, in conjunction with patients’ motion attempts, is intended to aid recovery by promoting the formation of new motor neural pathways.


Policy Guidelines

The American Spinal Injury Association (ASIA) Impairment Scale is a classification system used to describe the extent of spinal cord injury (SCI).


The ASIA Impairment Scale:

  1. Complete: No motor or sensory function is preserved in the sacral segments S4 - S5
  2. Incomplete: Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4 - S5
  3. Incomplete: Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3
  4. Incomplete: Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more
  5. Normal: Motor and sensory function are normal


Prior Approval:

Not applicable.



Neuromuscular Electrical Stimulation (NMES)

Neuromuscular Electrical Stimulation (NMES) may be considered medically necessary for disuse atrophy where the nerve supply to the muscle is intact and the member has any of the following non-neurological reasons for disuse atrophy:

  • Previous casting or splinting of a limb when unable to participate in physical therapy
  • Contractures due to scarring of soft tissue (e.g. burn scarring)
  • Hip replacement prior to initiation of physical therapy


Neuromuscular Electrical Stimulation (NMES), (eg. ARP Wave Neuro Therapy, Powerdot), for all other indications, including use where the nerve supply to the muscle is not intact, and injuries not meeting the above criteria are considered investigational and, therefore, not covered because their safety and/or efficacy cannot be established by review of the available published peer-reviewed literature.


Functional Electrical Stimulation (FES) Lower Extremities

Functional neuromuscular stimulation (FNS)/functional electrical stimulation (FES) (e.g, Parastep® Ambulation System) may be considered medically necessary to enable members with spinal cord injury (SCI) to ambulate when all of the following criteria are met:

  • Persons with intact lower motor units (L1 and below) (both muscle and peripheral nerve); and
  • Persons with muscle and joint stability for weight bearing at upper and lower extremities that can demonstrate balance and control to maintain an upright support posture independently; and
  • Persons that demonstrate brisk muscle contract to FES and have sensory perception of electrical stimulation sufficient for muscle contraction; and
  • Persons that possess high motivation, commitment and cognitive ability to use such device for walking; and
  • Persons that can transfer independently and can demonstrate standing tolerance for at least 3 minutes; and
  • Persons that can demonstrate hand and finger function to manipulate controls; and
  • Persons with at least 6-month post recovery spinal cord injury and restorative surgery; and
  • Persons without hip and knee degenerative disease and no history of long bone fracture secondary to osteoporosis; and
  • Persons that have demonstrated a willingness to use the device long term.


In addition to meeting all the above criteria, individuals with spinal cord injury (SCI) must have completed physical therapy (PT) training with the Parastep® Ambulation System. A physical therapy evaluation may be requested as part of any medical necessity review determination.


Individuals with a spinal cord injury (SCI) with the following conditions would not be considered candidates for the functional nerve stimulation (FNS)/functional electrical stimulation (FES) (e.g. Parastep® Ambulation System):

  • Individuals with cardiac pacemaker; or
  • Individuals with severe scoliosis or severe osteoporosis; or
  • Individuals with skin disease or cancer at area of stimulation; or
  • Individuals with irreversible contracture; or
  • Individuals with autonomic dysreflexia


Functional electrical stimulation (FES) for indications other than listed above as medically necessary is considered investigational. Based on the peer reviewed literature there is insufficient evidence demonstrating the devices impact on safety and effectiveness on health outcomes for any other indications.


All Other FES Devices

FES devices including but not limited to the following are considered home exercise equipment even when being used for muscle atrophy, and therefore, not medically necessary for all indications including those listed below.


ERGYS (leg cycle ergometer), REGYS (leg cycle ergometer), RT200 Elliptical, RT300 RES cycle ergometer (also referred to as FES bicycle), StimMaster Galaxy (FES exercise bike) or the RT600 Step and Stand Rehabilitation Therapy System for stationary exercise to prevent or reduce muscle atrophy in upper and lower extremities in individuals with hemiplegia or quadriplegia.


The FES Cycle Therapy System (RT300) is described as a neuromuscular electrical stimulation device to reduce spasticity or facilitate voluntary motor control in individuals with spinal cord injury. There is insufficient evidence the electrical neuromuscular stimulation provides any long term benefit in the rehabilitation of spinal cord patients. The evidence for decreasing contracture, preventing muscle loss or improving exercise capacity above and beyond that of simple rehabilitative techniques has not been proven. Exercise is beneficial and recommended but the equipment to perform exercise is not considered a medical necessity. The device is considered not medically necessary.


NESS H200 Handmaster NMS1 system or the RT300 FES cycle ergometer used for upper limb paralysis or hemiplegia; OR


FES devices including but not limited to the following are considered investigational for all indications including those listed below as the safety and effectiveness of these devices has not been established based on review of the peer reviewed medical literature.


NESS L300 Foot Drop System or NESS L300 Plus System used for foot drop in children and adults, as a result of cerebral palsy (CP), multiple sclerosis (MS), traumatic brain injury (TBI), stroke (CVA) or an incomplete spinal cord injury; OR


Walkaide or ODFS Dropped Foot Stimulator used for foot drop as a result of cerebral palsy (CP), multiple sclerosis (MS), traumatic brain injury (TBI), stroke (CVA), or an incomplete spinal cord injury.


Miscellaneous Electrical Devices

The following are considered investigational for all indications

  • Transcutaneous Electrical Stimulation (scrambler therapy)
  • Microcurrent Electrical Nerve Stimulation (MENS)
  • Frequency-specific microcurrent (FSM)
  • Bioelectric nerve block (electroceutical therapy)
  • Electro therapeutic point stimulation (ETPSSM)


EMG triggered NMES devices (eg Care ETS device) are considered investigational.


FES and NMES are investigational for all other indications, including but not limited to the following:

  • Bell's palsy; or
  • Cerebral palsy; or
  • For cardiac conditioning; or
  • Congestive heart failure; or
  • For general muscle strengthening in healthy individuals; or
  • For improving ambulatory function and muscle strength for progressive diseases (e.g., cancer, chronic heart failure, chronic obstructive pulmonary disease, multiple sclerosis, Parkinson's) in persons without spinal cord injury; or
  • For the treatment of denervated muscles; or
  • For the treatment of knee osteoarthritis; or
  • Upper extremity hemiplegia; or
  • To provide upper-extermity function in patients with nerve damage; or
  • Lymphedema; or
  • Scoliosis; or
  • Tissue Damage; or
  • After ACL/MCL repair; or
  • Lower back pain; or
  • Foot Drop (e.g. ODFS Dropped Foot Stimulator); or
  • Chronic Wounds; or
  • For accelerated muscle strengthening in athletes; or
  • For patellofemoral pain; or
  • For dysphagia


Procedure Codes and Billing Guidelines:

To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.

  • 0278T Transcutaneous electrical modulation pain reprocessing (eg, scrambler therapy), each treatment session (includes placement of electrodes)
  • E0744 Neuromuscular stimulator for scoliosis
  • E0745 Neuromuscular stimulator, electronic shock unit
  • E0764 Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program.
  • E0770 Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified.
  • E1399 Miscellaneous durable medical equipment


Selected References:

  • Hooker, SP, et al. Physiologic response to prolonged electrically stimulated leg-cycle exercise in the spinal cord injured. Archives of Physical Medicine and Rehabilitation 1990; vol 71: 863-869.
  • BeDell, KK, et al. Effects of functional electrical stimulation-induced lower extremity cycling on bone density of spinal cord-injured patients. American Journal of Physical Medicine and Rehabilitation, 1996; 75:29-34.
  • Yan T, Hui-Chan CW, Li LS. Functional electrical stimulation improves motor recovery of the lower extremity and walking ability of subjects with first acute stroke: a randomized placebo-controlled trial. Stroke 2005;36(1):80-5.
  • U.S. Food and Drug Administration (FDA), Medical Devices Database, Sigmedics, INC. Parastep FES Unit. P900038.
  • CMS National Coverage Determination: Decision Memo for Neuromuscular Electrical Stimulation (NMES) for Spinal Cord Injury (CAG-00153R).
  • Sigmedics, INC The Parastep I System.
  • Yale Journal of Biology and Medicine 85 (2012), pp. 201-215.Neuromuscular Electrical Stimulation for Skeletal Function. Barbara M. Doucet, Amy Lam, and Lisa Griffin.
  • National Multiple Sclerosis Society Functional Electrical Stimulation (FES).
  • ECRI. Hotline Response. Neuromuscular Electrical Stimulation for Improving Mobility and Motor Function Following Spinal Cord Injury. July 2012.
  • ECRI. Neuromuscular Electrical Stimulation for Hemiplgia. Plymouth Meeting (PA): ECRI 2008 October 10.  16 p. (ECRI Hotline Response).
  • American Academy of Orthopaedic Surgeons Second Look, Exercise Benefits Total Knee Arthroplasty and NMES.
  • J Orthop Sports Phys Ther. 2004 Jan;34(1):21-9. Neuromuscular Electrical Stimulation for Quadriceps Muscle Strengthening after Bilateral Total Knee Arthroplasty: A Case Series. Department of Physical Therapy, University of Florida.
  • Physical Therapy February 2012 vol. 92 no. 2 210-226. Early Neuromuscular Electrical Stimulation to Improve Quadriceps Muscle Strength After Total Knee Arthroplasty: A Randomized Controlled Trial.
  • Journal of Orthopaedic & Sports Physical Therapy. Volume 40. Number 7. July 2010. Effects of Neuromuscular Electrical Stimulation After Anterior Cruciate Ligament Reconstruction on Quadriceps Strength, Function, and Patient Oriented Outcomes: A Systemic Review.
  • Centers for Medicare & Medicaid Services. Decision Memo for Neuromuscular Electrical Stimulation (NMES) for Spinal Cord Injury (CAG-00153R). 2002
  • G. Monroe, A, Fusco. et. al., Clinical Study Walking Training with Foot Drop Stimulator Controlled by a Tilt Sensor to Improve Walking Outcomes: A Randomized Controlled Pilot Study in Patients with Stroke in Subacute Phase. Stroke Research and Treatment,Volume, doi:10.1155/2012/523564.
  • National Institute of Health (NIH), published in final edited form as: Neurorehabil Neural Repair. 2013 March; 27(3):200-207. Doi.10.1177/154596831246716. Diane L. Damjano, PhD, Laura A. Prosser, PhD, et. al.  Muscle Plasticity and Ankle Control after Repetitive use of a Functional Electrical Stimulation Device for Foot Drop in Cerebral Palsy.
  • Sasha M. Scott, et. al. Quantification of Gait Kinematics and Walking Ability of People with Multiple Sclerosis who are New Users of Functional Electrical Stimulation. J Rehabil Med 2013:45:364-369.
  • International FES Society
  • National Institute for Health and Clinical Excellence (NICE)Functional Electrical Stimulation for Foot Drop for Central Neurological Origin (IPG278) 2009.
  • National Institute for Health and Clinical Excellence (NICE) Stroke Rehabilitation Long Term Rehabilitation after Stroke, Clinical Guideline no. 162, 2013.
  • UpToDate. Management of Prognosis of Cerebral Palsy, Geoffrey Miller M.D., Topic last updated July 20, 2015.
  • Quandt Fanny and Hummel Friedhelm, The Influence of Functional Electrical Stimulation on Hand Motor Recovery in Stroke Patients: A Review, Experimental and Translational Stroke Medicine 2014
  • UpToDate. Management and prognosis of cerebral palsy. July 20, 2015.
  • Stein C, et al. Effects of electrical stimulation in spastic muscles after stroke: systematic review and meta-analysis of randomized controlled trials. Stroke 2015 Aug;46(8):2197-205.
  • Wang YH, et al. Full-movement neuromuscular electrical stimulation improves plantar flexor spasticity and ankle active dorsiflexion in stroke patients: a randomized controlled study. Clin Rehabil 2015 Aug 20
  • National Institute for Health and Care Excellence (NICE) Transcutaneous neuromuscular electrical stimulation for oropharyngeal dysphagia. May 2014.
  • Giggins OM, Fullen BM, Coughlan GF, et al. Neuromuscular electrical stimulation in the treatment of knee osteoarthritis: A systematic review and meta-analysis. Clin Rehabil. 2012;26(10):867-881.
  • Negm A, Lorbergs A, Macintyre NJ. Efficacy of low frequency pulsed subsensory threshold electrical stimulation vs placebo on pain and physical function in people with knee osteoarthritis: Systematic review with meta-analysis. Osteoarthritis Cartilage. 2013;21(9):1281-1289.
  • Taylor P, Barrett C, Mann G, et al. A feasibility study to investigate the effect of functional electrical stimulation and physiotherapy exercise on the quality of gait of people with multiple sclerosis. Neuromodulation. 2014;17(1):75-84; discussion 84.
  • Venugopalan L, Taylor PN, Cobb JE, et al. Upper limb functional electrical stimulation devices and their man-machine interfaces. J Med Eng Technol. 2015;39(8):471-479. PMID 26508077
  • Bauer P, et al. Functional electrical stimulation – assisted active cycling – therapeutic effects in patients with hemiparesis form 7 days to 6 months after stroke: a randomized controlled pilot study. Arch Phys Med Rehabil 2015 Feb;96(2):188-96.
  • Langeard A, et al. Does muscular electrical stimulation training of the lower limb have functional effects on the elderly?: a systematic review. Exp Gerontol 2017 Feb 17;91:88-98.
  • Miller L, et al. Functional electrical stimulation for foot drop in multiple sclerosis: a systematic review and meta-analysis of the effect on gait speed. Arch Phys Med Rehabil 2017 Jan 11 [Epub ahead of print].
  • ARP Wave Treatment-Accelerated Recovery Performance
  • Takeda K, Tanino G, Miyasaka H. Review of devices used in neuromuscular electrical stimulation for stroke rehabilitation. Medical Devices (Auckland, NZ). 2017;10:207-213. doi:10.2147/MDER.S123464.
  • Bistolfi A, et al. Evaluation of the effectiveness of neuromuscular electrical stimulation after total knee arthroplasty: a meta-analysis. Am J Phys Med Rehabil 2018 Feb;97(2):123-130
  • Martimbianco ALC, Torloni MR, Andriolo BNG, Porfírio GJM, Riera R. Neuromuscular electrical stimulation (NMES) for patellofemoral pain syndrome. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD011289. DOI: 10.1002/14651858.CD011289.pub2
  • Albertin, G., Hofer, C., Zampieri, S.,  Vogelauer, M., et al. (2018) In complete SCI patients, long-term functional electrical stimulation of permanent denervated muscles increases epidermis thickness, Neurological Research, 40:4, 277-282, DOI: 10.1080/01616412.2018.1436877
  • ECRI. MyndMove Functional Electrical Stimulation (MyndTec, Inc.) for Improving Upper Limb Function. Plymouth Meeting (PA): ECRI; 2020 Jul 15. (Clinical Evidence Assessment).
  • Berenpas F, Geurts AC, den Boer J, et al. Surplus value of implanted peroneal functional electrical stimulation over ankle-foot orthosis for gait adaptability in people with foot drop after stroke. Gait Posture. Jun 2019; 71: 157-162. PMID 31071538
  • Renfrew LM, Paul L, McFadyen A, et al. The clinical- and cost-effectiveness of functional electrical stimulation and ankle-foot orthoses for foot drop in Multiple Sclerosis: a multicentre randomized trial. Clin Rehabil. Jul 2019; 33(7): 1150-1162. PMID 30974955


Policy History:

  • July 2020 - Annual Review, Policy Revised
  • July 2019 - Annual Review, Policy Revised
  • August 2018 - Annual Review, Policy Revised
  • August 2017 - Annual Review, Policy Revised
  • August 2016 - Annual Review, Policy Revised
  • September 2015 - Annual Review, Policy Revised
  • November 2014 - Annual Review, Policy Revised
  • January 2014 - Annual Review, Revised and new policy created
  • January 2013 - Annual Review, Policy Renewed
  • January 2012 - Annual Review, Policy Renewed
  • February 2011 - Interim Review, Policy Revised
  • October 2010 - Annual Review, Policy Revised

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.


*CPT® is a registered trademark of the American Medical Association.