Blue Cross Blue Shield of Minnesota Medical Policy

 
 

Medical Policy:
X-32-014
Topic:
Cranial Electrotherapy Stimulation
Section:
Behavioral Health
Effective Date:
November 25, 2024
Issued Date:
November 25, 2024
Last Revision Date:
August 2019
Annual Review:
July 2024
 
 

Cranial electrotherapy stimulation, also known as cranial electrical stimulation, transcranial electrical stimulation, or electrical stimulation therapy, is a non-invasive method of brain stimulation. This therapy utilizes a device to deliver weak pulses of electrical current to the brain via electrodes located on the earlobes, mastoid processes, or scalp. Cranial electrotherapy stimulation is believed to affect brain regions associated with emotion regulation, pain, hormone production, and other related functions. Cranial electrotherapy stimulation aims to improve conditions such as anxiety, depression, insomnia, fibromyalgia, Alzheimer’s disease, and additional pain-related disorders.

A number of cranial electrical stimulators have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. These devices include, but are not limited to, the following: CES Ultra HealthPax; Alpha-Stim® Neurotone; LISS Cranial Stimulator; Transcranial Electrotherapy Stimulator-A (TESA) and the Cervella Cranial Electrotherapy Stimulator (CES).

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.

Use of cranial electrotherapy stimulation is considered EXPERIMENTAL/INVESTIGATIVE for all indications due to the lack of clinical evidence demonstrating an impact on improved health outcomes.

Home use of cranial electrotherapy stimulation devices is considered EXPERIMENTAL/INVESTIGATIVE for all indications due to the lack of clinical evidence demonstrating an impact on improved health outcomes.

A4596 E0732 E1399 






Denial Statements

No additional statements.



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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.

Acknowledgements:

CPT® codes copyright American Medical Association® 2023. All rights reserved.

CDT codes copyright American Dental Association® 2023. All rights reserved.