302 Form

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Medical Policy Electrical Stimulation for the Treatment of Arthritis Table of Contents • Policy: Commercial • Coding Information
• Information Pertaining to All Policies
• Policy: Medicare • Description
• References
• Authorization Information • Policy History

Policy Number: 302

BCBSA Reference Number: 1.01.27 (For Plans internal use only) Related Policies
• Transcutaneous Electrical Nerve Stimulation (TENS) #003 • Electrical Bone Growth Stimulation of the Appendicular Skeleton #499 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity

Electrical or electromagnetic stimulation is considered INVESTIGATIONAL for the treatment of osteoarthritis or rheumatoid arthritis.

Prior Authorization Information
Inpatient • For services described in this policy, precertification/preauthorization IS REQUIRED for all products if the procedure is performed inpatient.
Outpatient • For services described in this policy, see below for products where prior authorization might be required if the procedure is performed outpatient.

Outpatient Commercial Managed Care (HMO and POS) This is not a covered service. Commercial PPO and Indemnity This is not a covered service. CPT Codes / HCPCS Codes / ICD Codes The following codes are included below for informational purposes. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable.

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CPT Codes There is no specific CPT code for this service.

HCPCS Codes HCPCS codes: Code Description E0762 Transcutaneous electrical joint stimulation device system, includes all accessories Description Electrical and electromagnetic stimulation are being investigated to improve functional status and to relieve pain related to osteoarthritis and rheumatoid arthritis that are unresponsive to other standard therapies. Noninvasive electrical stimulators generate a weak electrical current within the target site using pulsed electromagnetic fields, capacitive coupling, or combined magnetic fields. In capacitive coupling, small skin pads or electrodes are placed on either side of the knee or wrist. Electrical stimulation is provided by an electronic device that noninvasively delivers a subsensory low-voltage, monophasic electrical field to the target site of pain. Pulsed electromagnetic fields are delivered via treatment coils placed over the skin. Combined magnetic fields deliver a time-varying field by superimposing that field onto an additional static magnetic field.

In basic research studies, pulsed electrical stimulation has been shown to alter chondrocyte-related gene expression in vitro and to have regenerative effects in animal models of cartilage injury. It is proposed that the device treats the underlying cause of the disease by stimulating the joint tissue and improving the overall health of the joint and that it provides a slow-acting, but longer-lasting improvement in symptoms. Therefore, pulsed electrical stimulation is proposed to be similar to bone stimulator therapy for fracture nonunion (see policy #499).
Summary Description Pulsed electrical and electromagnetic stimulation are being investigated to improve functional status and relieve pain related to osteoarthritis and rheumatoid arthritis that is unresponsive to other standard therapies. Electrical stimulation is provided using a device that noninvasively delivers a subsensory, low- voltage, monophasic electrical field to the target site of pain. Pulsed electromagnetic fields are delivered using coils placed over the skin.

Summary of Evidence For individuals who have arthritis who receive pulsed electrical or electromagnetic stimulation, the evidence includes systematic reviews and a number of small randomized controlled trials (RCTs). Relevant outcomes are symptoms, functional outcomes, health status measures, and treatment-related morbidity. A review of the literature did not find adequate evidence that use of pulsed electrical or electromagnetic stimulation for the treatment of arthritis improves health outcomes. A 2020 meta-analysis identified 15 randomized sham- controlled trials on treatment of osteoarthritis of the knee. There was some evidence of clinically and statistically significant improvement in pain, but no evidence of clinically significant improvement in stiffness, function, or quality of life. These conclusions are limited by methodologic shortcomings and inconsistent trial results. Variable results seen in more recent RCTs might also be related to the different devices and treatment durations used. Additional studies with larger numbers of subjects are needed. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

Policy History Date Action 5/2026 Annual policy review. Policy updated with literature review through January 12, 2026; references added. Policy statement unchanged. 5/2025 Annual policy review. Policy updated with literature review through January 22, 2025; no references added. Policy statement unchanged.

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5/2024 Annual policy review. References updated. Policy statements unchanged. 5/2023 Annual policy review. Description, summary, and references updated. Policy statement unchanged. 1/2023 Medicare information removed. See MP #132 Medicare Advantage Management for local coverage determination and national coverage determination reference.
4/2022 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 4/2021 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 4/2019 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 4/2017 Annual policy review. New references added. 7/2016 Annual policy review. New references added. 2/2015 Annual policy review. New references added. 3/2014 Annual policy review. New references added. 11/2011-4/2012 Medical policy ICD 10 remediation: Formatting, editing and coding updates.
No changes to policy statements.
1/19/2011 New policy, effective 1/19/2011 describing ongoing non-coverage.
Information Pertaining to All Blue Cross Blue Shield Medical Policies Click on any of the following terms to access the relevant information: Medical Policy Terms of Use Managed Care Guidelines Indemnity/PPO Guidelines Clinical Exception Process Medical Technology Assessment Guidelines References

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