Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 122 - DURABLE MEDICAL EQUIPMENT, PROSTHETIC ORTHOTICS AND SUPPLIES (DMEPOS) › Section 410-122-0515 - Neuromuscular Electrical Stimulator (NMES)

Current through Register Vol. 63, No. 7, July 1, 2024
Indications and limitations of coverage and medical
				appropriateness:
(1) A neuromuscular
			 electrical stimulator (NMES) uses electrodes to transmit an electrical impulse
			 to the skin over selected muscle groups. There are two broad categories of
			 NMES.
(2) NMES for treatment of
			 muscle atrophy.
(3) NMES devices in
			 this category stimulate the muscle when the client is in a resting state to
			 treat muscle atrophy.
(4) The
			 Division shall cover NMES to treat muscle atrophy specific to disuse atrophy
			 where nerve supply to the muscle is intact (including brain, spinal cord and
			 peripheral nerves) and to treat other non-neurological reasons for disuse
			 atrophy. Some examples would be casting or splinting of a limb, contracture due
			 to scarring of soft tissue as in burn lesions, and hip replacement surgery
			 (until orthotic training begins).
(5) NMES to enhance functional activity of
			 neurologically impaired clients: Specifically, the Division shall cover NMES
			 used to improve the ability to walk in clients with Spinal Cord Injury
			 (SCI).
(6) This type of NMES is
			 commonly referred to as functional electrical stimulation (FES). FES devices
			 are surface units that use electrical impulses to activate paralyzed or weak
			 muscles in precise sequence.
(7)
			 The Division shall only cover NMES/FES for SCI clients for walking, who meet
			 the following criteria:
(a) Client has
			 completed at least 32 physical therapy sessions, directly performed one-on-one
			 with the physical therapist with the NMES/FES device over a trial period of
			 three (3) months, with the specific goal of using the NMES/FES device to
			 achieve walking, not to reverse or retard muscle atrophy;
(b) Therapists with the sufficient skills to
			 provide these services are only employed at inpatient hospitals; outpatient
			 hospitals; comprehensive outpatient rehabilitation facilities; and outpatient
			 rehabilitation facilities;
(c) The
			 practitioner treating the client for SCI will use this trial period to properly
			 evaluate the person's ability to use the NMES/FES frequently and for the long
			 term; and
(d) The client meets all
			 of the following characteristics:
(e) Intact lower motor units (L1 and below)
			 (both muscle and peripheral nerve);
(f) Muscle and joint stability for weight
			 bearing at upper and lower extremities that demonstrates balance and control to
			 maintain an upright support posture independently;
(g) Demonstrated brisk muscle contraction to
			 NMES and sensory perception of electrical stimulation sufficient for muscle
			 contraction;
(h) High motivation,
			 commitment and cognitive ability to use NMES/FES devices for walking;
(i) Can transfer independently and
			 demonstrates independent standing tolerance for at least three
			 minutes;
(j) Demonstrated hand and
			 finger function to manipulate controls;
(k) At least six-month post recovery spinal
			 cord injury and restorative surgery;
(l) Hip and knee degenerative disease and no
			 history of long bone fracture secondary to osteoporosis; and
(m) Demonstrated willingness to use the
			 device long-term;
(n) NMES/FES for
			 walking is not covered in an SCI client with any of the following:
(A) Cardiac pacemaker;
(B) Severe scoliosis or severe
			 osteoporosis;
(C) Skin disease or
			 cancer at area of stimulation;
(D)
			 Irreversible contracture;
(E)
			 Autonomic dysflexia; or
(F)
			 Treatment of muscle weakness due to the following conditions (not
			 all-inclusive):
(i) Stroke; spinal cord
			 injury; peripheral nerve injury; other central nervous system, spinal or
			 peripheral nerve disease/condition affecting motor and/or sensory pathways
			 to/from the muscles being stimulated;
(ii) Documentation requirements: Submit
			 documentation that supports coverage criteria as specified in this rule are
			 met.