Medical policy: Threshold Electrical Stimulation as a Treatment of Motor Disorders

Número de política: MP 6.046

Fecha de entrada en vigor: 2/1/2026

Política

Threshold electrical stimulation as a treatment of motor disorders, including but not limited to cerebral palsy, is considered investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Cross-references:

• MP 6.020 Transcutaneous Electrical Nerve Stimulation
• MP 6.047 Interferential Current Stimulation
• MP 6.049 H-Wave Electrical Stimulation
• MP 6.050 Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
• MP 6.051 Neuromuscular and Functional Neuromuscular Electrical Stimulation

Variaciones del producto

Esta política solo se aplica a ciertos programas y productos administrados por Capital Blue Cross y está sujeta a variaciones en los beneficios. Consulte la información adicional a continuación.

FEP PPO - Consulte el Manual de Políticas Médicas de FEP.

Descripción/Antecedentes

Threshold electrical stimulation (TES), also known as therapeutic electrical stimulation, is distinct from neuromuscular electrical stimulation (NMES). TES is a low-level, subthreshold electrical stimulus that is typically applied at home during sleep. It is proposed that increased blood flow during a time of heightened hormone secretion (during sleep) results in increased muscle bulk.

Threshold electrical stimulation is provided by a small electrical generator, lead wires, and surface electrodes that are placed over the targeted muscles. The intensity of the stimulation is set at the sensory threshold and does not cause a muscle contraction.

Threshold electrical stimulation is described as the delivery of low-intensity electrical stimulation to target spastic muscles during sleep at home. The stimulation is not intended to cause muscle contraction. Although the mechanism of action is not understood, it is thought that low-intensity stimulation may increase muscle strength and joint mobility, leading to improved voluntary motor function. The technique has been used most extensively in children with spastic diplegia related to cerebral palsy but also in those with other motor disorders, such as spina bifida.

Devices used for threshold electrical stimulation are classified as "powered muscle stimulators." As a class, the U.S. Food and Drug Administration (FDA) describes these devices as "an electronically powered device intended for medical purposes that repeatedly contracts muscles by passing electrical currents through electrodes contacting the affected body area."

Fundamento

Summary of evidence

The studies published to date demonstrate that threshold electrical stimulation is not effective for treatment of spasticity, muscle weakness, reduced joint mobility, or motor function. Las pruebas son insuficientes para determinar que la tecnología da lugar a una mejora en el resultado neto para la salud.

Definiciones

N/D

Exención de responsabilidad

Las políticas médicas de Capital Blue Cross se utilizan para determinar la cobertura de tecnologías, procedimientos, equipos y servicios médicos específicos. Estas políticas médicas no constituyen asesoramiento médico y están sujetas a cambios según lo exija la ley o las pruebas clínicas aplicables de las directrices de tratamiento independientes. Los proveedores que brindan tratamiento son individualmente responsables de los consejos médicos y el tratamiento de los miembros. Estas políticas no son una garantía de cobertura o pago. El pago de las reclamaciones está sujeto a la determinación del programa de beneficios del miembro y la elegibilidad en la fecha del servicio, y a la determinación de que los servicios son médicamente necesarios y apropiados. El procesamiento final de una reclamación se basa en los términos del contrato que se aplican al programa de beneficios de los miembros, incluidas las limitaciones y exclusiones de beneficios. Si un proveedor o miembro tiene alguna pregunta sobre esta política médica, debe comunicarse con Servicios para proveedores o Servicios para miembros de Capital Blue Cross.

Información de codificación

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. La identificación de un código en esta sección no denota cobertura, ya que la cobertura está determinada por los términos de la información de beneficios del miembro. Además, no todos los servicios cubiertos son elegibles para un reembolso por separado.

Not medically necessary; therefore, not covered for threshold electrical stimulation as a treatment of motor disorders:

Referencias

1. Steinbok P, Reiner A, Kestle JR. Therapeutic electrical stimulation (ThresholdES) following selective posterior rhizotomy in children with spastic diplegic cerebral palsy: a randomized clinical trial. Dev Med Child Neurol. 1997; 39(8): 515-520.
2. Dali C, Hansen FJ, Pedersen SA, et al. Threshold electrical stimulation (TES) in ambulant children with cerebral palsy: a randomized double-blind placebo-controlled clinical trial. Dev Med Child Neurol. 2002; 44(6): 364-369.
3. van der Linden ML, Hazlewood ME, Aitchison AM, et al. Electrical stimulation of gluteus maximus in children with cerebral palsy: effects on gait characteristics and muscle strength. Dev Med Child Neurol. 2003; 45(6): 385-390.
4. Fehlings DL, Kirsch M, McComas A, et al. Evaluation of therapeutic electrical stimulation to improve muscle strength and function in children with types III/IV spinal muscular atrophy. Dev Med Child Neurol. 2002; 44(11): 741-744.
5. Ozer K, Chesher SP, Scheker LR. Neuromuscular electrical stimulation dynamic bracing for the management of upper-extremity spasticity in children with cerebral palsy. Dev Med Child Neurol. 2006; 48(7): 559-563.
6. Kerr C, McDowell BC, Cosgrove AP, et al. Electrical stimulation in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol. 2006; 48(11): 870-876.
7. Lanini S, Scheinberg A, Clark A. AACPDM systematic review of the effectiveness of therapy for children with cerebral palsy after botulinum toxin A injections. Dev Med Child Neurol. 2006; 48(6): 533-539.
8. The National Institute of Neurological Disorders and Stroke. Cerebral palsy: hope through research. Last modified Mar 2020.
9. Barkoudah E, Whitaker A. Cerebral palsy: treatment of altered motor tone and associated orthopedic conditions. In: UpToDate Online Journal [serial online]. Waltham, MA: UpToDate; updated July 15, 2025.
10. Merrill DR. Review of electrical stimulation in cerebral palsy and recommendations for future directions. Artif Organs. 2009; 33(10): 1111-1149.
11. Walker JL, Ryan SW, Coburn TR. Does threshold nighttime electrical stimulation benefit children with spina bifida? A pilot study. Clin Orthop Relat Res. 2011; 469(5): 1297-1301.
12. Cauraugh JH, Naik SK, Hsu WH, Coombes SA, Holt KG. Children with cerebral palsy: a systematic review and meta-analysis on gait and electrical stimulation. Clin Rehabil. 2010; 24(11): 963-978.