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 Article of Interest - Medicare

Medicare intends to cover use of Neuromuscular Electrical Stimulation to Help People with Spinal Cord Injury Walk

Centers for Medicaid and Medicare Services


The Centers for Medicare & Medicaid Services (CMS) announced today that it intends to expand Medicare coverage of Neuromuscular Electrical Stimulation (NMES) to assist people with spinal cord injuries in walking.


"CMS is committed to paying for technologies that promote the health and welfare of Medicare beneficiaries," said CMS Administrator Tom Scully. "This future policy will improve the quality of life for spinal chord injured patients who are able to use NMES to assist them in walking."


NMES uses electrical stimulation to activate paralyzed or weak muscles in precise sequence in an effort to enhance the standing and walking abilities of spinal cord injured individuals.  Since 1984 NMES has been covered for treatment of disuse atrophy where the nerve supply to the muscle is intact and where other non-neurological reasons for disuse are causing atrophy. All other uses of NMES were non-covered.


CMS has decided to issue, in the future, a national coverage decision that expands coverage to assistance in walking.


Not all spinal cord injured patients are able to use NMES devices for walking.


To ensure that only patients who can utilize and benefit from these devices receive them, Medicare intends to cover the use of NMES for walking for those persons with intact lower motor units (L1 and below), with at least 6-month post recovery spinal cord injury and restorative surgery, without hip and knee degenerative disease and no history of long bone fracture secondary to osteoporosis, who have demonstrated a willingness to use device long-term, who have completed regular sessions of physical therapy with the device over a period of three months, who can bear weight on their lower and upper extremities, maintain an upright posture independently, transfer independently, stand for at least 3 minutes, possess high motivation and commitment and cognitive ability to use such device for walking, demonstrate hand and finger function to manipulate the controls, and demonstrate brisk muscle contraction in response to NMES and have sensory perception of electrical stimulation sufficient for muscle contraction.  Also, the goal of therapy must be to train SCI patients on the uses of NMES/FES to achieve walking, not to reverse or retard muscle atrophy.


There are an estimated 11,000 new cases of spinal cord injury each year. Fifty-five percent of spinal cord injuries occur in persons between the ages of 16 to 30.   Medicare is a program of health care for senior citizens and disabled persons.

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