Functional Electrical Stimulation and Neuromuscular Electrical Stimulation. Number 0. 67. 7Policy. Aetna considers functional electrical stimulation FES e. Parastep I System medically necessary durable medical equipment DME to enable members with spinal cord injury SCI to ambulate when all of the following criteria are met Member has intact lower motor units L1 and below both muscle and peripheral nerve and. Member has joint stability to bear weight on upper and lower extremities, and has balance and control to maintain an upright posture independently and. Member demonstrated brisk muscle contraction to neuromuscular electrical stimulation and has sensory perception of electrical stimulation sufficient for muscle contraction and. Member has the cognitive ability to use such devices for walking and is highly motivated to use the device long term and. Member can transfer independently and stand for at least 3 minutes and. Member possesses hand and finger function to manipulate the controls and. Member is at least 6 months post recovery of spinal cord injury and restorative surgery and. Member does not have hip and knee degenerative disease and has no history of long bone fracture secondary to osteoporosis and. The member has successfully completed a training program, which consists of at least 3. Note These criteria are adapted from the Food and Drug Administration FDA labeling for Parastep I System as well as information provided in published studies. Replacement of a FES for walking is considered medically necessary if the original FES met criteria as medically necessary and is no longer under warranty and cannot be repaired. Exclusion Criteria Functional electrical stimulation for walking Parastep I System is spectifically contraindicated and has no proven value for members with SCI with any of the following Members with cardiac pacemakers or. Members with severe scoliosis or severe osteoporosis or. Members with skin disease or cancer at area of stimulation or. Members with irreversible contracture or. Members with autonomic dysreflexia. Aetna considers neuromuscular electrical stimulators NMES medically necessary DME for disuse atrophy where the nerve supply to the muscle is intact and the member has any of the following non neurological reasons for disuse atrophy Contractures due to burn scarring, or. Major knee surgery e. Fine Motor Skills Strengthening Activities For Elderly' title='Fine Motor Skills Strengthening Activities For Elderly' />Member has intact lower motor units L1 and below both muscle and peripheral nerve and. Take advantage of this ataglance look at the pages on the SCC website you most often visit. Use this as a tool to navigate quickly to info you need the most. Motor and cognitive skills decline. Campaign in the short term aimed at strengthening not only. Previous casting or splinting of a limb arm or leg, or. Recent hip replacement surgery before physical therapy begins NMES is considered medically necessary until physical therapy begins. NMES are specifically contraindicated and considered unproven in persons with cardiac pacemakers. Note More than 2 hours of NMES per day is considered not medically necessary protocols reported in the literature recommend no more than 2 hours of NMES treatment within a 2. Aetna considers FES of the upper extremities e. NESS H2. 00 Handmaster NMS1 System experimental and investigational for all indications, including improvement of muscle strength, reduction of spasticity and atrophy, and facilitation of functional motor movement due to any of the following conditions because its effectiveness for these indications has not been established Spinal cord injury or  Stroke cerebrovascular accidentCVA or Traumatic brain injury or. Fine Motor Skills Strengthening Activities For Elderly' title='Fine Motor Skills Strengthening Activities For Elderly' />Other upper motor neuron disorders e. Parkinsons disease. Aetna considers FES and NMES experimental and investigational for all other indications, including any of the following because its effectiveness for indications other than the ones listed above as medically necessary has not been established Bells palsy or. Cardiac conditioning or. Cerebral palsy or. Chronic obstructive pulmonary disease or. Congestive heart failure or. General muscle strengthening in healthy individuals or Improving ambulatory function and muscle strength for progressive diseases e. Treatment of denervated muscles or. Treatment of knee osteoarthritis or. Upper extremity hemiplegia. Note Aetna considers the FES exercise devices such as the FES Power Trainer, ERGYS, REGYS, Neuro. EDUCATOR, STim. Master Galaxy, RT2. Brother Ocr Software Not Installed. Inactivity is one of the reasons many elderly fail to thrive. Source American Academy of Family Physicians. Specialising in aged care activities and resources for Nursing Homes, Hostels and Adult Day Care Centres. Elliptical, RT3. 00 FES Cycle Ergometer also referred to as a FES bicycle, RT6. Step and Stand Rehabilitation Therapy System, and Spectra. STIM to be exercise equipment. Most Aetna plans exclude coverage of exercise equipment please check benefit plan descriptions for details. In addition, these stationary exercise devices are considered experimental and investigational to prevent or reduce muscle atrophy in upper and lower extremities in individuals with hemiplegia or quadriplegia and for all other indications. Aetna considers a form fitting conductive garment medically necessary DME only when it has been approved for marketing by the FDA, has been prescribed by a physician for use in delivering NMES that is considered medically necessary, and any of the following criteria is met The member can not manage without the conductive garment due to the large area or the large number of sites to be stimulated, and the stimulation would have to be delivered so frequently that it is not feasible to use conventional electrodes, adhesive tapes, and lead wires or. The member has a skin problem or other medical conditions that precludes the application of conventional electrodes, adhesive tapes, and lead wires or. The member requires electrical stimulation beneath a cast to treat disuse atrophy, where the nerve supply to the muscle is intact or. The member has a medical need for rehabilitation strengthening following an injury where the nerve supply to the muscle is intact. Aetna considers form fitting conductive garments experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established. Aetna considers diaphragmaticphrenic pacing e. Mark IV Breathing Pacemaker System, Neu. Rx DPS Diaphragm Pacing System, and the Neu. Rx DPS RA4 Respiratory Stimulation System medically necessary for the following indications For improvement of ventilatory function in stable, non acute members with SCI when all of the following criteria are met Member has high quadriplegia at or above C 3 and. There are viable phrenic nerves and. Members diaphragm and lung function are adequate and. Diaphragmatic pacing will allow the individual to breathe without the assistance of a mechanical ventilator for at least four continuous hours a day. For the treatment of central alveolar hypoventilation when all of the following criteria are met Age of 1. Have intact phrenic nerve function and. Have diaphragm movement with stimulation. For individuals with amyotrophic lateral sclerosis who meet the following criteria Age of 2. Experiencing chronic hypoventilation and. Have intact phrenic nerve function and. Have diaphragm movement with stimulation and. Diaphragmatic pacing is used as an alternative to mechanical ventilation. Replacement of a diaphragmaticphrenic stimulation system is considered medically necessary if the original diaphragmaticphrenic stimulation system met criteria as medically necessary and is no longer under warranty and cannot be repaired.