![]() ![]() Information in the below has been added for clarification purposes. Table: CPT Codes / HCPCS Codes / ICD-10 Codes Code Note: Aetna does not cover over-the-counter disposable ReliefBand devices, which are used for the treatment of motion sickness, because they do not meet Aetna’s definition of durable medical equipment. Treatment of post-traumatic stress disorderĪetna considers transcutaneous neuromodulation and auricular electrostimulation experimental and investigational for nausea, vomiting, motion sickness and other indications because of insufficient evidence of effectiveness. ![]() Treatment of post-operative immune dysfunction in individuals with lung cancer.Treatment of post-hemorrhoidectomy-associated pain and anxiety.Treatment of pain after total knee arthroplasty.Treatment of muscle spasticity following brain injury.Treatment of hemodialysis-associated fatigue.Treatment of chronic obstructive pulmonary disease.Reduction of incidence and severity of etomidate-induced myoclonus.Modulation of autonomic balance in heart transplant recipients.Management of post-operative catheter-related bladder discomfort in individuals undergoing transurethral resection of the prostate.Management of post-operative analgesia in individuals undergoing radical mastectomy.Improvement/promotion of post-operative of sleep quality and analgesic effect following video-assisted thoracoscopic surgery.Improvement on the quality of early recovery in patients undergoing gynecological laparoscopic surgery.Improvement of pregnancy rates in women undergoing in-vitro fertilization.Improvement of motor functions and self-care ability in children with cerebral palsy.Number: 0676 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background ReferencesĪetna considers transcutaneous electrical acupoint stimulation (prescription version ReliefBand devices) medically necessary for the treatment of post-operative nausea and chemotherapy-induced nausea that is unresponsive to antiemetics and other conservative therapies.Īetna considers transcutaneous electrical acupoint stimulation (prescription version PrimaBella or ReliefBand devices) medically necessary for the treatment of hyperemesis gravidarum that is unresponsive to other conservative medical therapy (e.g., change in diet, ginger capsules, vitamin B6).Īetna considers transcutaneous electrical acupoint stimulation experimental and investigational for the following indications because its effectiveness for these indications (not an all-inclusive list) has not been established:
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