Does E0745 require prior authorization?

Yes, E0745 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

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`E0745`, Neuromuscular stimulator, electronic shock unit

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Documentation Required

Claims may require medical records documentation to assess whether the member meets the clinical criteria for coverage; however, documentation does not guarantee coverage.
Documentation of prior treatments and treatment failures where applicable (e.g., prior pneumatic dilation, prior Heller myotomy, prior botulinum toxin injection) — several POEM reports specify use as 'rescue' after failed prior interventions.
For stent placement or palliative radiotherapy: documentation of inoperable/unresectable primary esophageal cancer and symptom burden (dysphagia score), and life expectancy considerations (to guide stent vs brachytherapy selection).
No explicit documentation requirements, test-result requirements, or medical-record documentation instructions are specified in this document excerpt.
Objective pre- and post-treatment measures used in trials and expected in documentation: Eckardt score, LES resting pressure (manometry), timed barium esophagogram results (esophageal emptying), EndoFLIP/EGJ distensibility where used, and follow-up endoscopy/pH monitoring for reflux after POEM.
For dysphagia therapies generally: baseline and follow-up instrumental swallowing assessment such as video-fluoroscopic swallowing study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) are commonly used and reported.

Key Coverage Criteria

Telerehabilitation delivery of swallowing therapy (as an alternative delivery model; limited evidence)
Speech therapy for treatment of dysphagia, regardless of the presence of a communication disability, for members who meet the criteria set forth below:
Member exhibits weight loss or malnutrition because he/she has dysphagia and is unable to obtain adequate nutrition orally;
Member has a history of, or is at high-risk for, recurrent aspirations or choking;
Member is unable to swallow and has a nasogastric or gastrotomy tube for nutrition;
Esophageal dilation for the treatment of symptomatic obstruction of the esophagus;

20 Active Policies

ANTHEM-DME.00022, Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES)

ANTHEM-CG-DME-03, Neuromuscular Stimulation in the Treatment of Muscle Atrophy

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

CIGNA-0160, Electrical Stimulation Therapy and Devices in a Home Setting

UHC-POL-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

AETNA-CPB-0625, Dysphagia Therapy

AETNA-CPB-0680, Electrical Stimulation for Chronic Ulcers

AETNA-CPB-0679, Levator Syndrome Treatments

AETNA-CPB-0011, Peripheral Electrical Nerve Stimulation for Pain

AETNA-CPB-0614, Huntington's Disease

AETNA-CPB-0707, Headaches: Invasive Procedures

AETNA-CPB-0755, Motor Cortex Stimulation

AETNA-CPB-0362, Spasticity Management

AETNA-CPB-0374, Trigeminal Neuralgia: Treatments

AMBETTER-CP.MP.137, Fecal Incontinence Treatments

AMBETTER-CP.MP.48, Neuromuscular and Peroneal Nerve Electrical Stimulation (NMES)

BCBSIL-SUR710.018, Sacral Nerve Neuromodulation/Stimulation

BCBSIL-MED201.026, Surface Electrical Stimulation

BCBSMT-SUR710.018, Sacral Nerve Neuromodulation/Stimulation

BCBSMT-MED201.026, Surface Electrical Stimulation

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E0745, Neuromuscular stimulator, electronic shock unit

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Documentation Required

Claims may require medical records documentation to assess whether the member meets the clinical criteria for coverage; however, documentation does not guarantee coverage.
Documentation of prior treatments and treatment failures where applicable (e.g., prior pneumatic dilation, prior Heller myotomy, prior botulinum toxin injection) — several POEM reports specify use as 'rescue' after failed prior interventions.
For stent placement or palliative radiotherapy: documentation of inoperable/unresectable primary esophageal cancer and symptom burden (dysphagia score), and life expectancy considerations (to guide stent vs brachytherapy selection).
No explicit documentation requirements, test-result requirements, or medical-record documentation instructions are specified in this document excerpt.
Objective pre- and post-treatment measures used in trials and expected in documentation: Eckardt score, LES resting pressure (manometry), timed barium esophagogram results (esophageal emptying), EndoFLIP/EGJ distensibility where used, and follow-up endoscopy/pH monitoring for reflux after POEM.
For dysphagia therapies generally: baseline and follow-up instrumental swallowing assessment such as video-fluoroscopic swallowing study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) are commonly used and reported.

Key Coverage Criteria

Telerehabilitation delivery of swallowing therapy (as an alternative delivery model; limited evidence)
Speech therapy for treatment of dysphagia, regardless of the presence of a communication disability, for members who meet the criteria set forth below:
Member exhibits weight loss or malnutrition because he/she has dysphagia and is unable to obtain adequate nutrition orally;
Member has a history of, or is at high-risk for, recurrent aspirations or choking;
Member is unable to swallow and has a nasogastric or gastrotomy tube for nutrition;
Esophageal dilation for the treatment of symptomatic obstruction of the esophagus;

20 Active Policies

ANTHEM-DME.00022, Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES)

ANTHEM-CG-DME-03, Neuromuscular Stimulation in the Treatment of Muscle Atrophy

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

CIGNA-0160, Electrical Stimulation Therapy and Devices in a Home Setting

UHC-POL-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

AETNA-CPB-0625, Dysphagia Therapy

AETNA-CPB-0680, Electrical Stimulation for Chronic Ulcers

AETNA-CPB-0679, Levator Syndrome Treatments

AETNA-CPB-0011, Peripheral Electrical Nerve Stimulation for Pain

AETNA-CPB-0614, Huntington's Disease

AETNA-CPB-0707, Headaches: Invasive Procedures

AETNA-CPB-0755, Motor Cortex Stimulation

AETNA-CPB-0362, Spasticity Management

AETNA-CPB-0374, Trigeminal Neuralgia: Treatments

AMBETTER-CP.MP.137, Fecal Incontinence Treatments

AMBETTER-CP.MP.48, Neuromuscular and Peroneal Nerve Electrical Stimulation (NMES)

BCBSIL-SUR710.018, Sacral Nerve Neuromodulation/Stimulation

BCBSIL-MED201.026, Surface Electrical Stimulation

BCBSMT-SUR710.018, Sacral Nerve Neuromodulation/Stimulation

BCBSMT-MED201.026, Surface Electrical Stimulation

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about E0745 Sign up free

`E0745`, Neuromuscular stimulator, electronic shock unit

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`E0745`, Neuromuscular stimulator, electronic shock unit

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

E0745, Neuromuscular stimulator, electronic shock unit

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

E0745, Neuromuscular stimulator, electronic shock unit

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`E0745`, Neuromuscular stimulator, electronic shock unit

`E0745`, Neuromuscular stimulator, electronic shock unit