CurrentCapital BluecrossPolicy MP 6.046

Threshold Electrical Stimulation as a Treatment of Motor Disorders

This policy governs coverage of threshold electrical stimulation (TES) as a treatment for motor disorders (for example, cerebral palsy) for members of Capital Blue Cross programs to which the policy applies.

Policy Summary

PayerCapital Bluecross

PolicyThreshold Electrical Stimulation as a Treatment of Motor Disorders

Policy CodePolicy MP 6.046

Change TypeNo material changes

Effective DateFeb 1, 2026

Next Review Date

Key ActionDo not submit claims for threshold electrical stimulation (E0745) for motor disorders; this service is designated not medically necessary and is not a covered benefit where this policy applies.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not medically necessarycoverage stance

E0745procedure code

Insufficientevidence

Limitedproduct variation

Coverage Criteria

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Investigational / Not covered

Policy statement

Primary coverage determination: Threshold electrical stimulation as a treatment of motor disorders (including but not limited to cerebral palsy) is considered investigational; evidence is insufficient to demonstrate benefit

Resulting coverage stance: not medically necessary / not covered as listed

This policy is only applicable to certain programs and products administered by Capital Blue Cross and is subject to benefit variations. Providers should verify member benefit plan and eligibility prior to rendering services because applicability and coverage depend on the member’s specific product. Federal Employee Program (FEP) PPO coverage is governed by the FEP Medical Policy Manual; refer to that manual for FEP PPO determinations.

The policy-level coverage determination is that threshold electrical stimulation (TES) as a treatment of motor disorders is not medically necessary and is therefore not covered. As listed in the policy, the specific procedure code identified as not covered is E0745. Because the service is designated not medically necessary where this policy applies, it is excluded from coverage under those Capital Blue Cross products.

Provider Actions

Prior Authorization

Prior authorization — TES (E0745) not a covered benefit

Prior authorization is not applicable. Threshold electrical stimulation (TES) billed with HCPCS code E0745 is considered not medically necessary and is not a covered benefit for treatment of motor disorders.

Affected code: E0745 (Threshold electrical stimulation)

Note

Benefit verification and claim adjudication

Verify member eligibility and benefit plan details before providing services. Final claim payment is subject to the member's benefits, eligibility on the date of service, and the terms of the applicable contract.

Confirm product variations and program applicability (e.g., FEP PPO refers to FEP Medical Policy Manual).

Denial Risk

Coverage denial trigger — TES (E0745)

Claims submitted for TES (E0745) may be denied as not medically necessary and not covered. Do not expect separate reimbursement for this procedure under covered plans.

Claims for HCPCS code E0745 may be denied.

Note

Provider administrative note (placeholder)

(Reserved) Administrative note for providers.

Background

Threshold electrical stimulation (TES) is a low‑intensity, sensory‑threshold electrical stimulus applied over target muscles, typically delivered with surface electrodes and a small generator during sleep. TES is distinct from neuromuscular electrical stimulation because it is applied at a sensory threshold and does not produce muscle contraction. The technique has been used primarily in children with spastic diplegia from cerebral palsy and other motor disorders, with proposed mechanisms including increased blood flow during sleep and possible increases in muscle bulk; however, available studies have not demonstrated effectiveness for treatment of spasticity or muscle weakness, and the therapy is therefore considered investigational for these indications.

Definitions

Threshold electrical stimulation (TES) — definition and characteristics

DefinitionLow-level, sensory-threshold electrical stimulation applied over target muscles (typically at home during sleep) that does not cause muscle contraction; delivered by a small generator, lead wires, and surface surface electrodes.

Typical applicationApplied at home during sleep to target spastic muscles (most extensively used in children with spastic diplegia from cerebral palsy; also used in other motor disorders such as spina bifida).

Key characteristicsStimulation intensity set at the sensory threshold (subcontraction), does not elicit muscle contraction, proposed mechanism includes increased blood flow during sleep leading to increased muscle bulk.

Device componentsSmall electrical generator, lead wires, and surface electrodes placed over targeted muscles.

Distinct from NMESTES is distinct from neuromuscular electrical stimulation (NMES); TES delivers low-intensity, sensory-threshold stimulation and is not intended to cause contraction, whereas NMES elicits muscle contraction.

Powered muscle stimulators — FDA classification and definition

FDA classification (class description)Classified by the U.S. Food and Drug Administration as 'powered muscle stimulators' — an electronically powered device intended for medical purposes that repeatedly contracts muscles by passing electrical currents through electrodes contacting the affected body area.

Brief definitionDevices that deliver electrical stimulation to muscles using a powered generator and electrodes; for TES, devices deliver stimulation at sensory threshold and are not intended to elicit contraction.

Typical use contextUsed to provide threshold electrical stimulation to target spastic muscles, most commonly in home-based sleep application for patients with spastic diplegia related to cerebral palsy.