Wednesday, August 28, 2019

CPT 97813, 97814, S8930 - Cranial electrotherapy stimulation (CES)

Coding  Code Description CPT

97813 Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

97814 Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)

HCPCS

S8930
Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient


Cranial Electrotherapy Stimulation and Auricular Electrostimulation

Introduction


Cranial electrotherapy stimulation (CES) provides weak levels of electrical current to the brain. Electrodes are placed on the skull, earlobes, eyelids, or forehead. A small transmitter then sends weak electrical pulses into the brain. It’s believed the current affects particular areas of the brain that play important roles in the body’s hormones and emotions. Another use of CES calls for treating pain by placing the electrodes near the site of pain. Auricular stimulation sends electrical pulses to the acupuncture points of the ear. Both of these systems have been used for depression, anxiety, insomnia (sleeplessness), and weight loss. Because there is not enough medical evidence showing that these technologies improve health, both are considered unproven. 

A small device worn behind the ear that stimulates specific nerves to try to relieve symptoms of opioid withdrawal is unproven. More research is needed to determine if this device is effective.

Note:   The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria. The rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for providers. A provider can be a person, such as a doctor, nurse, psychologist, or dentist. A provider also can be a place where medical care is given, like a hospital, clinic, or lab. This policy informs them about when a service may be covered.


Policy Coverage Criteria 

Procedure Investigational

Cranial electrotherapy stimulation


Cranial electrotherapy stimulation (also known as cranial electrostimulation therapy or CES) is investigational in all situations.

Electrical stimulation Electrical stimulation of auricular acupuncture points is investigational in all situations.  Electrical stimulation of the ear (also known as auricular neurostimulation) for opioid withdrawal is investigational.


Evidence Review 

Description


Cranial electrotherapy stimulation (CES), also known as cranial electrical stimulation, transcranial electrical stimulation, or electrical stimulation therapy, delivers weak pulses of electrical current to the earlobes, mastoid processes, or scalp with devices such as the Alpha-Stim. Auricular electrostimulation involves stimulation of acupuncture points on the ear. Devices, including the P-Stim and E-pulse, provide ambulatory auricular electrical stimulation over a period of several days. CES is being evaluated for a variety of conditions, including pain, insomnia, depression, anxiety, and functional constipation. Auricular electrical stimulation is being evaluated for pain, weight loss, and opioid withdrawal.

Background

Cranial electrotherapy stimulation (CES), also known as cranial electrical stimulation, transcranial electrical stimulation, or electrical stimulation therapy, delivers weak pulses of electrical current to the earlobes, mastoid processes, or scalp with devices such as the Alpha-Stim®. Auricular electrostimulation involves stimulation of acupuncture points on the ear. Devices, including the P-Stim™ and E-pulse, provide ambulatory auricular electrical stimulation over a period of several days. CES and Auricular electrostimulation are being evaluated for a variety of conditions, including pain, insomnia, and depression, anxiety, weight loss and opioid withdrawal.

Interest in CES began in the early 1900s with the theory that weak pulses of electrical current have a calming effect on the central nervous system. The technique was further developed in the U.S.S.R. and Eastern Europe in the 1950s as a treatment for anxiety and depression, and use of CES later spread to Western Europe and the United States as a treatment for a variety of psychological and physiological conditions. Presently, the mechanism of action is thought to be the modulation of activity in brain networks by direct action in the hypothalamus, limbic system, and/or the reticular activating system. One device used in the Unites States is the Alpha-Stim® CES, which provides pulsed, low-intensity current via clip electrodes that attach to the earlobes. Other devices place the electrodes on the eyelids, frontal scalp, mastoid processes, or behind the ears. Treatments may be administered once or twice daily for a period of several days to several weeks.


Other devices provide electrical stimulation to auricular acupuncture sites over several days. One device, the P-Stim™, is a single-use miniature electrical stimulator for auricular acupuncture points that is worn behind the ear with a self-adhesive electrode patch. A selection stylus that measures electrical resistance is used to identify 3 auricular acupuncture points. The P-Stim™ device connects to 3 inserted acupuncture needles with caps and wires. The device is preprogrammed to be on for 180 minutes, then off for 180 minutes. The maximum battery life of this single-use device is 96 hours.


Summary of Evidence  Cranial Electrotherapy Stimulation

For individuals who have acute or chronic pain who receive CES, the evidence includes a number of small sham-controlled randomized trials, and pooled analyses. Three trials studied headache and CES, and 5 trials studied chronic pain and CES. Pooled analyses found marginal benefits for headache treatment with CES and no benefits for chronic pain with CES. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have psychiatric, behavioral, or neurologic conditions (eg, depression and anxiety, Parkinson disease, addiction) who receive CES, the evidence includes a number of small sham-controlled randomized trials. Relevant outcomes are symptoms, morbid events, functional outcomes, and treatment-related morbidity.

Three RCTs evaluated CES for depression and anxiety and reported inconsistent outcomes. Comparisons between these trials cannot be made due to the heterogeneity in study populations and treatment protocols. Studies evaluating CES for Parkinson disease and smoking cessation do not support the use of CES for these conditions. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have functional constipation who receive CES, the evidence includes an RCT. Relevant outcomes are symptoms, morbid events, functional outcomes, and treatment-related morbidity. The single RCT reported positive results for the treatment of constipation with CES. However, the trial was unblinded, and most outcomes were self-reported. The evidence is insufficient to determine the effects of the technology on health outcomes.

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