Electrical stimulation therapies (TENS, FES, NMES, and related modalities)
Governs medical necessity and coverage of external and implanted electrical stimulation therapies for Louisiana members, including TENS, FES, NMES, and various percutaneous and peripheral neuromodulation modalities. Affects providers requesting authorization or billing for these services in Louisiana.
Retired policy; Louisiana plan membership disenrolled on Apr. 1, 2026.
Notations added indicating HCPCS codes A4438, A4556, A4557, A4593, and A4594 are not on the State of Louisiana Medicaid Fee Schedule and therefore are not covered by the State of Louisiana Medicaid Program.
Removed notation indicating HCPCS code E0770 is not on the State of Louisiana Medicaid Fee Schedule and therefore are not covered by the State of Louisiana Medicaid Program.
Updated Description of Services, Clinical Evidence, FDA, and References sections to reflect the most current information and archived previous policy version CS036LA.U.
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