Does S8130 require prior authorization?

No, S8130 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for S8130?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S8130`, Interferential current stimulator, 2 channel

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

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.
No other explicit documentation requirements, prior-authorization criteria, ICD-10 diagnoses, frequency limits, or billing/coding instructions are provided in this document excerpt.

Key Coverage Criteria

PENS (ICD-10 codes covered if selection criteria are met): M79.2 Neuralgia and neuritis, unspecified [neuropathic pain]
Transcutaneous Electrical Nerve Stimulators (TENS) medically necessary when used as an adjunct or as an alternative to the use of drugs either in the treatment of acute post-operative pain in the first 30 days after surgery, or for certain types of chronic, intractable pain not adequately responsive to other methods of treatment including, as appropriate, physical therapy and pharmacotherapy.
When TENS is used for acute post-operative or chronic intractable pain, initial medically necessary use is for a trial period of at least 1 month but not to exceed 2 months, monitored by the physician to determine effectiveness.
Form-fitting conductive garment medically necessary DME only when it has been approved for marketing by the FDA, has been prescribed by a doctor for delivering TENS for one of the medically necessary indications listed above, and any of the following criteria is met: the member cannot manage without the conductive garment due to large area or number of sites to be stimulated and frequent delivery is required; or the member has a medical need for rehabilitation strengthening following an injury w [...]
G90.50 - G90.59 Complex regional pain syndrome I (CRPS I) (covered if selection criteria are met for peripherally implanted nerve stimulators)
S14.101S - S14.159S; S14.2xxS - S14.9xxS; S24.101S - S24.159S; S24.2xxS - S24.9xxS; S34.101S - S34.139S; S34.21xS - S34.9xxS; S44.8x1S - S44.92xS; S54.8x1S - S54.92xS; S64.8x1S - S64.92xS; S74.8x1S - S74.92xS; S84.801S - S84.92xS; S94.8x1S - S94.92xS (spinal cord injury, injury to nerve root(s), spinal plexus(s), and other nerves of trunk, injury to peripheral nerve of shoulder girdle and upper limb, or injury to peripheral nerve of pelvic girdle and lower limb, sequela) — covered if selection c [...]

11 Active Policies

ANTHEM-DME.00011, Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices

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

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

BCBSIL-MED201.041, Interferential Current Stimulation

BCBSMT-MED201.041, Interferential Current Stimulation

BCBSNM-MED201.041, Interferential Current Stimulation

BCBSOK-MED201.041, Interferential Current Stimulation

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

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

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

REGENCE-DME83.07, Interferential Current Stimulation

`S8130`, Interferential current stimulator, 2 channel

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

S8130, Interferential current stimulator, 2 channel

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

`S8130`, Interferential current stimulator, 2 channel