Latest Review Date: June 2024

Category: Durable Medical Equipment (DME)                                                                    

POLICY:

Interferential current stimulation (IFS or IFS Sequential Stimulator) is considered investigational.

DESCRIPTION OF PROCEDURE OR SERVICE:

Interferential current stimulation (IFS) is a type of electrical stimulation used to reduce pain. The technique has been proposed to decrease pain and increase function in patients with osteoarthritis and to treat other conditions such as constipation, irritable bowel syndrome, dyspepsia, and spasticity.

Interferential current stimulation (IFS) is a type of electrical stimulation that has been investigated as a technique to reduce pain, improve function and range of motion, and treat gastrointestinal disorders.

This stimulation uses paired electrodes of 2 independent circuits carrying high-frequency and medium-frequency alternating currents. The superficial electrodes are aligned on the skin around the affected area. It is believed that IFS permeates tissues more effectively with less unwanted stimulation of cutaneous nerves, is more comfortable than transcutaneous electrical nerve stimulation. There are no standardized protocols for the use of IFS; IFS may vary by the frequency of stimulation, the pulse duration, treatment time, and electrode-placement technique.

KEY POINTS:

The most recent literature was reviewed through April 22, 2024. Following is a summary of the key literature to date.

SUMMARY OF EVIDENCE:

For individuals who have musculoskeletal conditions who receive interferential current stimulation (IFS), the evidence includes randomized controlled trials (RCTs) and meta-analyses. Relevant outcomes are symptoms, functional outcomes, quality of life, medication use, and treatment-related morbidity. Placebo-controlled RCTs of IFS for treating musculoskeletal pain and impaired function have mostly found that it does not significantly improve outcomes. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have gastrointestinal disorders who receive IFS, the evidence includes RCTs. Relevant outcomes are symptoms, functional outcomes, quality of life, medication use and treatment-related morbidity. IFS has been tested for a variety of gastrointestinal conditions, with a small number of trials completed for each condition. Trials results are mixed, with some reporting benefit and others not. This body of evidence is inconclusive on whether IFS is an efficacious treatment for gastrointestinal conditions. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have post stroke spasticity who receive IFS, the evidence includes RCTs. Relevant outcomes are symptoms, functional outcomes, quality of life, and treatment-related morbidity. The RCTs had small sample sizes and very short follow-up (immediately post treatment to 5 weeks). The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

Practice Guidelines and Position Statements:

American College of Physicians and the American Pain Society

Clinical practice guidelines from the American College of Physicians and the American Pain Society, published in 2009, concluded that there was insufficient evidence to recommend interferential stimulation for the treatment of low back pain. An update of these guidelines by the American College of Physicians (2017) confirmed the 2009 findings that there was insufficient evidence to determine the effectiveness of interferential current stimulation (IFS) for the treatment of low back pain. 

American College of Occupational and Environmental Medicine

The American College of Occupational and Environmental Medicine published several relevant guidelines. For shoulder disorders, guidelines found the evidence on IFS to be insufficient and, depending on the specific disorder, either did not recommend IFS or were neutral on whether to recommend it. For low back disorders, guidelines found the evidence on IFS to be insufficient and did not recommend it. For knee disorders, guidelines recommended IFS for postoperative anterior cruciate ligament reconstruction, meniscectomy, and knee chondroplasty immediately postoperatively in the elderly. This was a level C recommendation.

National Institute for Health and Care Excellence

In 2016, the National Institute for Health and Care Excellence had a guideline (NG59) on assessment and management of low back pain and sciatica in people aged 16 and over. The guideline states “Do not offer interferential therapy for managing low back pain with or without sciatica”.

U.S. Preventive Services Task Force Recommendations

Not applicable

KEY WORDS:

Interferential current therapy (IF), interferential stimulation (IF), interferential stimulator, transcutaneous electrical nerve stimulation (TENS), sequential stimulator, RS-4i Sequential stimulator, Medstar™ 100, RS-4i®

APPROVED BY GOVERNING BODIES:

A number of IFS devices have been cleared for marketing by the U.S. Food and Drug Administration through the 510(k) process, including the Medstar™ 100 (MedNet Services) and the RS-4i® (RS Medical). IFS may be included in multimodal electrotherapy devices such as transcutaneous electrical nerve stimulation and functional electrostimulation.

BENEFIT APPLICATION:

Coverage is subject to member’s specific benefits.  Group-specific policy will supersede this policy when applicable.

ITS: Home Policy provisions apply

FEP contracts: Special benefit consideration may apply. Refer to member’s benefit plan. 

CURRENT CODING:

CPT CODES:

HCPCS CODES:

REFERENCES:

1. Albornoz-Cabello M, Maya-Martin J, Dominguez-Maldonado G, et al. Effect of interferential current therapy on pain perception and disability level in subjects with chronic low back pain: A randomized controlled trial. Clin Rehabil. Mar 14 2016.
2. Alqualo-Costa R, Rampazo EP, Thome GR, et al. Interferential current and photobiomodulation in knee osteoarthritis: A randomized, placebo-controlled, double-blind clinical trial. Clin Rehabil. Oct 2021; 35(10): 1413- 1427.
3. American College of Occupational and Environmental Medicine. (ACOEM) Chronic pain. Available online at: www.guidelines.gov. 
4. American College of Occupational and Environmental Medicine (ACOEM). Shoulder Disorders. Available online at: www.guideline.gov. 
5. American College of Occupational and Environmental Medicine (ACOEM). Low Back Disorders. Available online at: www.guideline.gov. 
6. American College of Occupational and Environmental Medicine (ACOEM). Knee Disorders. Available online at: www.guideline.gov. 
7. Artuç ŞE, Uçkun AÇ, Sivas FA, et al. Comparison of the effects of transcutaneous electrical nerve stimulation and interferential current therapies in central sensitization in patients with knee osteoarthritis. Korean J Pain. Jul 01 2023; 36(3): 392-403.
8. Atamaz FC, Durmaz B, Baydar M et al. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study. Arch Phys Med Rehabil 2012; 93(5):748-56.
9. Coban S, Akbal E, Koklu S et al. Clinical trial: transcutaneous interferential electrical stimulation in individuals with irritable bowel syndrome - a prospective double-blind randomized study. Digestion 2012; 86(2):86-93.
10. Correa JB, Costa LO, de Oliveira NT et al. Effects of the carrier frequency of interferential current on pain modulation in patients with chronic nonspecific low back pain: a protocol of a randomized controlled trial. BMC Musculoskelet Disord 2013; 14:195.
11. Dissanayaka TD, Pallegama RW, Suraweera HJ, et al. Comparison of the effectiveness of transcutaneous electrical nerve stimulation and interferential therapy on the upper trapezius in myofascial pain syndrome: a randomized controlled study. Am J Phys Med Rehabil. Mar 4 2016.
12. Eslamian F, Farhoudi M, Jahanjoo F, et al. Electrical interferential current stimulation versus electrical acupuncture in management of hemiplegic shoulder pain and disability following ischemic stroke-a randomized clinical trial. Arch Physiother. 2020; 10: 2.
13. Facci LM, Nowotny JP, Tormem F et al. Effects of transcutaneous electrical nerve stimulation (TENS) an interferential currents (IFC) in patients with nonspecific chronic low back pain: randomized controlled trial. Sao Paulo Med J 2011; 129(4):206-16.
14. Fuentes JP, Armijo Olivo S, Magee DJ et al. Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis. Phys Ther 2010; 90(9):1219-38.
15. Gundog M, Atamaz F, Kanyilmaz S, et al. Interferential current therapy in patients with knee osteoarthritis: comparison of the effectiveness of different amplitude-modulated frequencies. Am J Phys Med Rehabil. Feb 2012; 91(2):107-113.
16. Hegmann KT, Travis R, Andersson GBJ, et al. Non-Invasive and Minimally Invasive Management of Low Back Disorders. J Occup Environ Med. Mar 2020; 62(3): e111-e138.
17. Hussein HM, Alshammari RS, Al-Barak SS, et al. A systematic review and meta-analysis investigating the pain relieving effect of interferential current on musculoskeletal pain. Am J Phys Med Rehabil. Aug 31 2021.
18. IOM (Institute of Medicine). 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press.
19. Kajbafzadeh AM, Sharifi-Rad L, Nejat F et al. Transcutaneous interferential electrical stimulation for management of neurogenic bowel dysfunction in children with myelomeningocele. Int J Colorectal Dis 2012; 27(4):453-8.
20. Koca I, Boyaci A, Tutoglu A, et al. Assessment of the effectiveness of interferential current therapy and TENS in the management of carpal tunnel syndrome: a randomized controlled study. Rheumatol Int. Apr 12 2014.
21. Koca I, Boyaci A, Tutoglu A, et al. Assessment of the effectiveness of interferential current therapy and TENS in the management of carpal tunnel syndrome: a randomized controlled study. Rheumatol Int. Dec 2014; 34(12):1639-1645.
22. Koklu S, Koklu G, Ozguclu E et al. Clinical trial: interferential electric stimulation in functional dyspepsia patients - a prospective randomized study. Aliment Pharmacol Ther 2010; 31(9):961-968.
23. Lara-Palomo IC, Aguilar-Ferrandiz ME, Mataran-Penarrocha GA, et al. Short-term effects of interferential current electro-massage in adults with chronic non-specific low back pain: a randomized controlled trial. Clin Rehabil. May 2013; 27(5):439-449.
24. Moore JS, Gibson PR, Burgell RE. Randomised clinical trial: transabdominal interferential electrical stimulation vs sham stimulation in women with functional constipation. Aliment Pharmacol Ther. Apr 2020; 51(8): 760-769.
25. Suh HR, Han HC, Cho HY. Immediate therapeutic effect of interferential current therapy on spasticity, balance, and gait function in chronic stroke patients: a randomized control trial. Clin Rehabil. Sep 2014; 28(9):885-891.
26. Zeng C, Li H, Yang T, et al. Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthritis Cartilage. Feb 2015; 23(2):189-202.

POLICY HISTORY:

Medical Policy Group, October 2002

Medical Policy Administration Committee, October 2002

Available for comment December 18, 2002-February 3, 2003

Medical Policy Group, November 2004 (4)

Medical Policy Group, June 2005 (3)

Medical Review Committee, June 2005 (2)

Medical Policy Administration Committee, July 2005

Available for comment July 28-September 10, 2005

Medical Policy Group, November 2006 (1)

Medical Policy Group, November 2008 (1)

Medical Policy Group, September 2010 (1)

Medical Policy Administration Committee, September 2010

Available for comment September 14-October 28, 2010

Medical Policy Group, November 2010

Medical Policy Group, December 2011 (3): 2012 Code Updates – Added Codes S8130 & S8131

Medical Policy Group, March 2012 (3): 2011 Literature Update, updated Key Points and References

Medical Policy Panel, December 2012

Medical Policy Group, December 2012 (3): 2012 Literature Update, updated Key Points and References.  Policy statement remains unchanged

Medical Policy Panel, December 2013

Medical Policy Group, January 2014 (3): 2013 Updates to Key Points and References; no change in policy statement; removed policy statements greater than 3 years old

Medical Policy Panel, December 2014

Medical Policy Group, January 2015 (3): 2014 Updates to Key Points and References, no change in policy statement

Medical Policy Panel, June 2016

Medical Policy Group, July 2016 (6): Updates to Description of Procedure or Services, Policy, Key Points, Summary, Approved by Governing Bodies and References, removed 2012 previous coding; no change in policy intent.

Medical Policy Panel, September 2017

Medical Policy Group, September 2017 (6): Updates to Key Points and Coding.

Medical Policy Group, December 2017: Annual Coding Update 2018.  Updated verbiage for revised CPT code 64550.

Medical Policy Panel, June 2018

Medical Policy Group, June 2018 (6): Updates to Key Points, Practice Guidelines, Governing Bodies and References.

Medical Policy Group, December 2018: 2019 Annual Coding Update. Moved CPT code from Current coding section to Previous coding. Created Previous coding section to include code 64550.

Medical Policy Panel, June 2019

Medical Policy Group, June 2019 (6): Updates to Key Points.

Medical Policy Panel, June 2020

Medical Policy Group, June 2020 (6): Updates to Key Points, Key Words (Medstar™ 100, RS-4i®) Governing Bodies and Practice Guidelines.

Medical Policy Panel, June 2021

Medical Policy Group, June 2021 (6): Updates to Key Points, Practice Guidelines and References.

Medical Policy Panel, June 2022

Medical Policy Group, June 2022 (6): Updates to Key Points and References.

Medical Policy Panel, June 2023

Medical Policy Group, June 2023 (6): Updates to Description, Key Points, Benefit Application and References.

Medical Policy Panel, June 2024

Medical Policy Group, June 2024 (6) Updates to Key Points and References. Title updated to: Interferential Current Stimulation.

This medical policy is not an authorization, certification, explanation of benefits, or a contract. Eligibility and benefits are determined on a case-by-case basis according to the terms of the member’s plan in effect as of the date services are rendered. All medical policies are based on (i) research of current medical literature and (ii) review of common medical practices in the treatment and diagnosis of disease as of the date hereof. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels of care and treatment.

This policy is intended to be used for adjudication of claims (including pre-admission certification, pre-determinations, and pre-procedure review) in Blue Cross and Blue Shield’s administration of plan contracts.

The plan does not approve or deny procedures, services, testing, or equipment for our members. Our decisions concern coverage only. The decision of whether or not to have a certain test, treatment or procedure is one made between the physician and his/her patient. The plan administers benefits based on the member’s contract and corporate medical policies. Physicians should always exercise their best medical judgment in providing the care they feel is most appropriate for their patients. Needed care should not be delayed or refused because of a coverage determination.

As a general rule, benefits are payable under health plans only in cases of medical necessity and only if services or supplies are not investigational, provided the customer group contracts have such coverage.

The following Association Technology Evaluation Criteria must be met for a service/supply to be considered for coverage:

1. The technology must have final approval from the appropriate government regulatory bodies;

2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes;

3. The technology must improve the net health outcome;

4. The technology must be as beneficial as any established alternatives;

5. The improvement must be attainable outside the investigational setting.

Medical Necessity means that health care services (e.g., procedures, treatments, supplies, devices, equipment, facilities or drugs) that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease or its symptoms, and that are:

1. In accordance with generally accepted standards of medical practice; and

2. Clinically appropriate in terms of type, frequency, extent, site and duration and considered effective for the patient’s illness, injury or disease; and

3. Not primarily for the convenience of the patient, physician or other health care provider; and

4. Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.