CMS Pub. 100-03, ch. 1, § 230.8

CIM 60-24

Non-implantable pelvic floor electrical stimulators provide neuromuscular electrical stimulation through the

pelvic floor with the intent of strengthening and exercising pelvic floor musculature. Stimulation is generally

delivered by vaginal or anal probes connected to an external pulse generator.

The methods of pelvic floor electrical stimulation vary in location, stimulus frequency (Hz), stimulus

intensity or amplitude (mA), pulse duration (duty cycle), treatments per day, number of treatment days per

week, length of time for each treatment session, overall time period for device use and between clinic and

home settings. In general, the stimulus frequency and other parameters are chosen based on the patient’s

clinical diagnosis.

Pelvic floor electrical stimulation with a non-implantable stimulator is covered for the treatment of stress

and/or urge urinary incontinence in cognitively intact patients who have failed a documented trial of pelvic

muscle exercise (PME) training.

A failed trial of PME training is defined as no clinically significant improvement in urinary continence after

completing 4 weeks of an ordered plan of pelvic muscle exercises designed to increase periurethral muscle

strength.