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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that electrical stimulation (ES) and electromagnetic therapy have been used or studied for many 
different applications, one of which is accelerating wound healing. ES for the treatment of wounds is the 
application of electrical current through electrodes placed directly on the skin in close proximity to the wound. 
Electromagnetic therapy uses a pulsed magnetic field to induce current. The Centers for Medicare & Medicaid 
Services (CMS) was asked to reconsider its national non-coverage determination for electromagnetic therapy. 
After thorough review, CMS determined that the results from the use of electromagnetic therapy for the 
treatment of wounds were similar to the results from the use of ES. Therefore, effective July 1, 2004, Medicare 
will cover electromagnetic therapy for the same settings and conditions for which ES is covered. This means 
Medicare will allow either one covered ES therapy or one covered electromagnetic therapy for the treatment of 
wounds. 
 
A. Nationally Covered Indications 
The use of ES and electromagnetic therapy for the treatment of wounds are considered adjunctive therapies and 
will only be covered for chronic Stage III or Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and 
venous stasis ulcers. Chronic ulcers are defined as ulcers that have not healed within 30 days of occurrence. ES 
or electromagnetic therapy will be covered only after appropriate standard wound therapy has been tried for at 
least 30 days and there are no measurable signs of improved healing. This 30-day period may begin while the 
wound is acute. 
 
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. Standard wound care based on the specific 
type of wound includes: frequent repositioning of a patient with pressure ulcers (usually every 2 hours), 
offloading 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. 
 
Measurable signs of improved healing include: a decrease in wound size (either surface area or volume), 
decrease in amount of exudates, and decrease in amount of necrotic tissue. ES or electromagnetic therapy must 
be discontinued when the wound demonstrates 100% epithelialized wound bed. ES and electromagnetic therapy services can only be covered when performed by a physician, physical 
therapist, or incident to a physician service. Evaluation of the wound is an integral part of wound therapy. 
When a physician, physical therapist, or a clinician incident to a physician, performs ES or electromagnetic 
therapy, the practitioner must evaluate the wound and contact the treating physician if the wound worsens. If 
ES or electromagnetic therapy is being used, wounds must be evaluated at least monthly by the treating 
physician. 
 
B. Nationally Non-Covered Indications 
1. ES and electromagnetic therapy will not be covered as an initial treatment modality. 
 
2. Continued treatment with ES or electromagnetic therapy is not covered if measurable signs of healing have 
not been demonstrated within any 30-day period of treatment. 
 
3. Unsupervised use of ES or electromagnetic therapy for wound therapy will not be covered, as this use has 
not been found to be medically reasonable and necessary. 
 
You can find these rules in the National Coverage Determination (NCD) Electrical Stimulation (ES) and 
Electromagnetic Therapy for the Treatment of Wounds 270.1. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.