Medical Policy Notification: Services for electrical stimulation as Experimental/Investigational

Dec. 19, 2017

Medical Policies are based on data from the peer-reviewed scientific literature, from criteria developed by specialty societies and from guidelines adopted by other health care organizations. Since its respective publication, Blue Cross and Blue Shield of Montana Medical Policy has considered the services for electrical stimulation as Experimental/Investigational. However, BCBSMT did not enforce this policy on a pre-pay basis.

Medical Policies are reviewed annually and posted with 90 days notification. The policies regarding electrical stimulation were reviewed and posted on the Medical Policy site.

We recognize that some providers may not have been aware of this Medical Policy as the services were historically reimbursed. However, BCBSMT has an expectation of providers to adhere to and practice within the realm of medical necessity and appropriate services. BCBSMT will not recover reimbursements previously paid for these services. Provider appeals rights are available and are described in the Provider Manual.

https://providerportal.bcbsmt.com/Documents/ProviderManuals/2014Chapter12Appeals.docx

If you need additional information about this notification, please contact your Provider Network Consultant.