Prior authorization request form Form

Biomagnetic Therapy
Proprietary information of EmblemHealth/ConnectiCare. © 2025 EmblemHealth & Affiliates POLICY NUMBER LAST REVIEW MG.MM.ME.59C9 August 8, 2025

Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth the clinical evidence that the member meets the criteria for the treatment or surgical procedure. Without this documentation and information, EmblemHealth will not be able to properly review the request preauthorization or post-payment review. The clinical review criteria expressed below reflects how EmblemHealth determines whether certain services or supplies are medically necessary. This clinical policy is not intended to pre-empt the judgment of the reviewing medical director or dictate to health care providers how to practice medicine. Health care providers are expected to exercise their medical judgment in rendering appropriate care. Health care providers are expected to exercise their medical judgment in rendering appropriate care.
EmblemHealth established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). EmblemHealth expressly reserves the right to revise these conclusions as clinical information changes and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by EmblemHealth, as some programs exclude coverage for services or supplies that EmblemHealth considers medically necessary.
If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. Identification of selected brand names of devices, tests and procedures in a medical coverage policy is for reference only and is not an endorsement of any one device, test or procedure over another. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. All coding and web site links are accurate at time of publication.
EmblemHealth may also use tools developed by third parties, such as the MCG™ Care Guidelines, to assist us in administering health benefits. The MCG™ Care Guidelines are intended to be used in connection with the independent professional medical judgment of a qualified health care provider and do not constitute the practice of medicine or medical advice. EmblemHealth Services Company, LLC, has adopted this policy in providing management, administrative and other services to EmblemHealth Plan, Inc., EmblemHealth Insurance Company, EmblemHealth Services Company, LLC, and Health Insurance Plan of Greater New York (HIP) related to health benefit plans offered by these entities. All of the aforementioned entities are affiliated companies under common control of EmblemHealth Inc. Definitions Biomagnetic therapy (aka magnetic therapy, magnetherapy, magnotherapy, static magnetic field therapy or therapeutic magnets) consists of placing a magnet on or near the skin using a variety of devices (e.g., bracelets, necklaces, insoles, sleeves, head bands, mattress pads, etc.) to create an electromagnetic field to areas of musculoskeletal damage or perceived discomfort. Proposed uses include degenerative joint conditions such as osteoarthritis, joint and tendon injury.
Guideline Biomagnetic therapy is considered investigational and not medically necessary.
Limitations and Exclusions Biomagnetic therapy, in any capacity, is not considered medically necessary for pain management (or any disease/condition) due to insufficient evidence of therapeutic value.

Proprietary information of EmblemHealth/ConnectiCare, Inc. © 2025 EmblemHealth & Affiliates

Page 2 of 2 Procedure Codes
97799 Unlisted physical medicine/rehabilitation service or procedure References

1. Carpenter JS, Wells N, Lambert B, et al. A pilot study of magnet therapy for hot flashes after breast cancer. Cancer Nursing. 2002; 25(2):104-109.
2. Cepeda MS, Carr DB, Sarquis T, et al. Static magnetic therapy does not decrease pain or opioid requirements: a randomized double-blind trial. Anesth Analg. 2007; 104(2):290-294.
3. Cheong YC, Smotra G, Williams AC. Non-surgical interventions for the management of chronic pelvic pain. Cochrane Database Syst Rev. 2014; (3):CD008797.
4. Colbert AP, Markov MS, Carlson N, et al. Static magnetic field therapy for carpal tunnel syndrome: a feasibility study. Arch Phys Med Rehabil. 2010; 91(7):1098-1104.
5. Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database of Syst Rev. 2003; (3):CD000416.
6. National Center for Complimentary and Integrative Health. Magnets for pain relief. Updated December 2017. Available at: https://nccih.nih.gov/health/magnet/magnetsforpain.htm. Accessed August 15, 2024.
7. Pittler MH, Brown, EM, Ernst E. Static magnets for reducing pain: systematic review and meta-analysis of randomized trials. CMAJ. 2007; 177(7):736-742.
8. Richmond SJ, Brown SR, Campion PD, et al. Therapeutic effects of magnetic and copper bracelets in osteoarthritis: a randomised placebo-controlled crossover trial. Complement Ther Med. 2009; 17(5-6):249-256.
9. Richmond SJ, Gunadasa S, Bland M, Macpherson H. Copper bracelets and magnetic wrist straps for rheumatoid arthritis-analgesic and anti-inflammatory effects: a randomised double-blind placebo-controlled crossover trial. PLoS One. 2013; 8(9):e71529.
10. Specialty matched clinical peer review.
11. Stones W, Cheong YC, Howard FM. Interventions for treating chronic pelvic pain in women. Cochrane Database of Syst Rev. 2005; (2):CD000387.
12. Winemiller MH, Billow RG, Laskowski ER, et al. Effect of magnetic vs. sham-magnetic insoles on plantar heel pain. JAMA. 2003; 290(11):1474-1478.
13. Wolsko PM, Eisenberg DM, Simon LS, et al. Double-blind placebo-controlled trial of static magnets for the treatment of osteoarthritis of the knee: results of a pilot study. Alternative Therapies. 2004; 10(2):36-43. Revision History Company(ies) DATE REVISION EmblemHealth Aug. 8, 2025 Transferred policy content to individual company branded template ConnectiCare Dec. 2019 ConnectiCare adopts the clinical criteria of its parent corporation EmblemHealth