CMS Pub. 100-04, ch. 32, § 11.1

A. Coding Applicable to Carriers & Fiscal Intermediaries (FIs)

Effective April 1, 2003, a National Coverage Decision was made to allow for Medicare coverage of Electrical

Stimulation for the treatment of certain types of wounds. The type of wounds covered are chronic Stage III or Stage

IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers. All other uses of electrical stimulation for

the treatment of wounds are not covered by Medicare. Electrical stimulation will not be covered as an initial

treatment modality.

The use of electrical stimulation will only be covered after appropriate standard wound care has been tried for at least

30 days and there are no measurable signs of healing. If electrical stimulation is being used, wounds must be

evaluated periodically by the treating physician but no less than every 30 days by a physician. Continued treatment

with electrical stimulation is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment. Additionally, electrical stimulation must be discontinued when the wound demonstrates a

100% epithelialzed wound bed.

Coverage policy can be found in Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Section

270.1 (http://www.cms.hhs.gov/manuals/103_cov_determ/ncd103index.asp)

The applicable Healthcare Common Procedure Coding System (HCPCS) code for Electrical Stimulation and the

covered effective date is as follows:

HCPCS Definition Effective Date

G0281 Electrical Stimulation, (unattended), to one

or more areas for chronic Stage III and

Stage IV pressure ulcers, arterial ulcers,

diabetic ulcers and venous stasis ulcers not

demonstrating measurable signs of healing

after 30 days of conventional care as part

of a therapy plan of care.

04/01/2003

Medicare will not cover the device used for the electrical stimulation for the treatment of wounds. However,

Medicare will cover the service. Unsupervised home use of electrical stimulation will not be covered.

B. FI Billing Instructions

The applicable types of bills acceptable when billing for electrical stimulation services are 12X, 13X, 22X, 23X, 71X,

73X, 74X, 75X, and 85X. Chapter 25 of this manual provides general billing instructions that must be followed for

bills submitted to FIs. FIs pay for electrical stimulation services under the Medicare Physician Fee Schedule for a

hospital, Comprehensive Outpatient Rehabilitation Facility (CORF), Outpatient Rehabilitation Facility (ORF),

Outpatient Physical Therapy (OPT) and Skilled Nursing Facility (SNF).

Payment methodology for independent Rural Health Clinic (RHC), provider-based RHCs, free-standing Federally

Qualified Health Center (FQHC) and provider based FQHCs is made under the all-inclusive rate for the visit

furnished to the RHC/FQHC patient to obtain the therapy service. Only one payment will be made for the visit

furnished to the RHC/FQHC patient to obtain the therapy service. As of April 1, 2005, RHCs/FQHCs are no longer

required to report HCPCS codes when billing for these therapy services.

Payment Methodology for a Critical Access Hospital (CAH) is on a reasonable cost basis unless the CAH has elected

the Optional Method and then the FI pays115% of the MPFS amount for the professional component of the HCPCS

code in addition to the technical component.

In addition, the following revenues code must be used in conjunction with the HCPCS code identified:

Revenue Code Description

420 Physical Therapy

430 Occupational Therapy

520 Federal Qualified Health Center *

521 Rural Health Center *

977, 978 Critical Access Hospital- method II

CAH professional services only

* NOTE: As of April 1, 2005, RHCs/FQHCs are no longer required to report HCPCS codes when billing for these

therapy services.

C. Carrier Claims

Carriers pay for Electrical Stimulation services billed with HCPCS codes G0281 based on the MPFS. Claims for

Electrical Stimulation services must be billed on Form CMS-1500 or the electronic equivalent following instructions

in chapter 12 of this manual (http://www.cms.hhs.gov/manuals/104_claims/clm104c12.pdf).

D. Coinsurance and Deductible

The Medicare contractor shall apply coinsurance and deductible to payments for these therapy services except for

services billed to the FI by FQHCs. For FQHCs, only co-insurance applies.