Electrostimulation for Wounds

CMS NCA document | source_status=Closed | review_type=1st Recon | public_comment_open=False | document_id=CAG-00068R

CMS determines that the results from electromagnetic stimulation of chronic, nonhealing wounds are similar to the results from electrical stimulation of similar wounds and that both are reasonable and necessary for the treatment of chronic, nonhealing wounds. Therefore, we will modify our current national coverage determination to add coverage for electromagnetic stimulation. CMS determines that the current evidence is not adequate to conclude that electromagnetic stimulation improves outcomes in settings outside those covered for electrical stimulation and will, therefore, limit coverage of electromagnetic stimulation to those settings and conditions for which electrical stimulation is covered. Therefore, it is our intention to modify CIM 35-102 to allow for coverage for the use of electrical and electromagnetic stimulation for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers. All other uses of electrical and electromagnetic 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 and electromagnetic therapy for the treatment of wounds will not be covered as an initial treatment modality. The use of electrical and electromagnetic 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 and electromagnetic stimulation therapy. Continued treatment with electrical and electromagnetic stimulation is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment. Electrical and electromagnetic stimulation should be discontinued when the wound demonstrates a 100% epithelialzed wound bed. Electrical and electromagnetic stimulation for wound healing are not covered in the home setting, as unsupervised use by patients in the home has not been found to be medically reasonable and necessary.