Decision on National Coverage of Electromagnetic Therapy for Wounds

Advances in Skin & Wound Care, Jul/Aug 2004 by Schaum, Kathleen D

Q: Did the Centers for Medicare & Medicaid Services (CMS) reconsider its national noncoverage determination for electromagnetic therapy?

A: Yes. After a thorough review, the CMS determined that the use of electromagnetic therapy for the treatment of wounds had similar results to the use of electrical stimulation. As of july 1, 2004, Medicare now covers electromagnetic therapy for the same settings and conditions as it does for electrical stimulation. Medicare will allow coverage of either 1 electrical stimulation therapy or I electromagnetic therapy for the treatment of wounds.

Q: What is the difference between electrical stimulation and electromagnetic therapy?

A: When electrical stimulation is used to treat wounds, electrical current is applied through electrodes placed directly on the skin in close proximity to the wound. Electromagnetic therapy uses a pulsed magnetic field to induce current.

Q: What are the nationally covered indications for these therapies?

A: Both electrical stimulation and electromagnetic therapy are considered adjunctive therapy for the treatment of wounds. They are covered for the following indications:

* chronic Stage III or Stage IV pressure ulcers

* arterial ulcers

* diabetic ulcers

* venous stasis ulcers.

Q: How does CMS define "chronic ulcers?"

A: CMS defines chronic ulcers as those that have not healed within 30 days of occurrence. Electrical stimulation or electromagnetic therapy will be covered only after appropriate standard wound therapy has been tried for at least 30 days, with no measurable signs of improved healing. Note that the prescribed 30-day period may begin while the wound is acute.

Q: What does CMS consider as "standard wound care?"

A: According to CMS, "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 treatment necessary to resolve any infection that may be present.

CMS lists additional standards of care based on specific wound types:

* pressure ulcers: frequent repositioning of a patient (usually every 2 hours)

* diabetic ulcers: off-loading of pressure and good glucose control

* arterial ulcers: establishment of adequate circulation

* venous ulcers: use of a compression system.

Q: What does CMS mean by "measurable signs of improved healing?"

A: Measurable signs of improved wound healing include decrease in wound size (either surface area or volume), decrease in amount of exudatc, and decrease in amount of nccrotic tissue.

Electrical stimulation or electromagnetic therapy must be discontinued when the wound demonstrates a 100% cpithelialized wound bed.

Q: Which professionals will Medicare pay to perform electrical stimulation and electromagnetic therapy services?

A: Both therapy services are covered only when performed by a physician or a physical therapist or when "incident to" a physician service.

The treating physician must evaluate the wounds at least monthly during treatment with electrical stimulation or electromagnetic therapy.

Q: Are there any noncovered indications for this type of therapy?

A: Yes. The following are noncovered indications for electrical stimulation and electromagnetic therapy:

* when used as an initial treatment modality

* if measurable signs of healing have not been demonstrated within any 30-day period of treatment

* if therapy is unsupcrviscd (including unsupervised home use of either therapy).

Q: What are the HCPCS codes and national resource-based relative value scale (RBRVS) fee schedule rates for both therapies?

A: See Table 1 for the HCPCS codes and RBRVS fee schedule rates effective july 1, 2004. see Table 2 for a list of revenue codes that facilities should use in conjunction with the HCPCS codes.

Q: Is the National Coverage Determination binding for all Medicare contractors?

A: Yes. The National Coverage Determination is binding to all Medicare contractors. That includes carriers, fiscal intermediaries, quality improvement organizations, health maintenance organizations, competitive medical plans, health care prepayment plans, and Medicare Choice organizations.

Q: Is there any Medicare coverage for the electrical stimulation or electromagnetic therapy devices?

A: No, Medicare does not cover these devices.

Kathleen D. Schaum, MS

Kathleen D. Schaum, MS, is President of Kathleen D. Schaum & Associates, lnc, Lake Worth, FL Ms Schaum can be reached for questions and consultations by calling 5617 -9647 -2470 or through her e-mail address: kathleendschaum@bellsouth.net. Submit your questions for Payment Strategies by mail to: Kathleen D. Schaurn, MS, 6491 Rock Creek Dr, Lake Worth, FL 33467. Information regarding payment is provided as a service to our readers, but does not guarantee that payment will be received. Providers are responsible for case-by- case documentation and justification of medical necessity.