Electrostimulation for Wounds

CMS NCA document | source_status=Closed | review_type=New | public_comment_open=False | document_id=CAG-00068N

Electrical stimulation is defined as the application of electrical current through electrodes applied directly to the skin in close proximity to the ulcer. Based on all of the evidence that we have reviewed in this matter, it is our intention to issue a positive coverage decision only on the use of electrical stimulation for "chronic" Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers. All other uses of electrical stimulation for the treatment of wounds are noncovered. Chronic ulcers are defined as ulcers that have not healed within 30 days of occurrence. Electrical stimulation for the treatment of wounds will not be covered as an initial treatment modality. The use of electrical stimulation will be covered as adjunctive therapy only after there are no measurable signs of healing for at least 30-days of treatment with standard wound therapy and must be used in addition to standard wound care. Measurable signs of improved healing include a decrease in wound size either in surface area or volume, decrease in amount of exudates and decrease in amount of necrotic tissue. Standard wound care includes: optimization of nutritional status; debridement by any means to remove devitalized tissue; maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings; and necessary treatment to resolve any infection that may be present. Specific wound care based on type of wound includes: frequent repositioning of a patient with pressure ulcers (usually every 2 hours); off-loading of pressure and good glucose control for diabetic ulcers; establishment of adequate circulation for arterial ulcers and the use of a compression system for patients with venous ulcers. Wounds must be evaluated at least every 30 days during administration of electrical stimulation therapy. Continued treatment with electrical stimulation is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment.