Blue Cross Blue Shield of Minnesota Medical Policy


Medical Policy:
Interferential Current Stimulation
Ancillary Services
Effective Date:
May 31, 2021
Issued Date:
May 31, 2021
Last Revision Date:
May 2021
Annual Review:
May 2021

This policy version was replaced May 30, 2022. To find the newest version, go to, read and accept the Blue Cross Medical Policy Statement, then select “Blue Cross and Blue Shield of Minnesota Medical Policies.” This will bring up the Medical Policy search screen. Enter the policy number without the version number (last 3 digits).

Interferential current stimulation is a type of electrical stimulation used to reduce pain. The technique has been proposed to increase function in patients with osteoarthritis and to treat other conditions such as dyspepsia, irritable bowel syndrome, and constipation.

Interferential current stimulation (IFS) uses paired electrodes of 2 independent circuits carrying high-frequency and medium-frequency alternating currents. The superficial electrodes are aligned on the skin around the affected area. It has been suggested that IFS permeates the tissues more effectively with less unwanted stimulation of cutaneous nerves and is more comfortable than transcutaneous electrical nerve stimulation. IFS has been investigated as a technique to reduce pain, improve range of motion, and treat gastrointestinal disorders. There are no standardized protocols for the use of IFS. IFS may vary by frequency of stimulation, the pulse duration, treatment time, and electrode-placement technique.

A number of IFS devices have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process, including the RS-4i®. Many of these devices are marketed directly to consumers.

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Policy Position Coverage is subject to the specific terms of the member's benefit plan.

Interferential current stimulation is considered EXPERIMENTAL/INVESTIGATIVE for all indications, including but not limited to musculoskeletal and gastrointestinal disorders, due to a lack of clinical evidence demonstrating an impact on improved health outcomes.

97014 G0283 S8130 S8131

Denial Statements

No additional statements.


Blue Cross and Blue Shield of Minnesota medical policies apply generally to all Blue Cross and Blue Plus plans and products. Benefit plans vary in coverage and some plans may not provide coverage for certain services addressed in the medical policies. When determining coverage, reference the member’s specific benefit plan, including exclusions and limitations.

Medicaid products may provide different coverage for certain services, which may be addressed in different policies. For Minnesota Health Care Program (MHCP) policies, please consult the MHCP Provider Manual website.

Medicare products may provide different coverage for certain services, which may be addressed in different policies. For Medicare National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and/or Local Coverage Articles, please consult CMS, National Government Services, or CGS websites. 

Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.

Blue Cross and Blue Shield of Minnesota reserves the right to revise, update and/or add to its medical policies at any time without notice. Codes listed on this policy are included for informational purposes only and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. 

These guidelines are the proprietary information of Blue Cross and Blue Shield of Minnesota. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.


CPT® codes copyright American Medical Association® 2022. All rights reserved.

CDT codes copyright American Dental Association® 2022. All rights reserved.