E0745 Neuromuscular stim for shockNeuromuscular stimulator, electronic shock unit
48 of 48 payer prior-auth lists that name E0745 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Humana, Medicare, Neighborhood Health Partnership, Oxford Health Plans, Rocky Mountain Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Medicare | DMEPOS Master List (items potentially subject to PA) | All | prior auth under conditions | On the Master List; PA only if CMS selects it for the Required List | Jul 30, 2026 | Master List of DMEPOS Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements |
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2024 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
| Humana | Humana Healthy Horizons | KY | prior auth required | Jan 1, 2027 | please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. | |
| Humana | Humana Healthy Horizons | VA | prior auth required | Jan 1, 2027 | Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) | |
| Humana | Humana Puerto Rico MA and Dual Medicare-Medicaid | PR | prior auth required | Nov 3, 2025 | Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification | |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $1,000. Advance notification required when members are referred to an out-of- netwo | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| Oxford Health Plans | Oxford Health Plans | All | prior auth under conditions | Notification/prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500. | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 |
| Rocky Mountain Health Plans | Rocky Mountain Health Plans CHP+ | CO | prior auth required | Oct 1, 2026 | Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026 | |
| Rocky Mountain Health Plans | Rocky Mountain Health Plans Prime / RAE | CO | prior auth required | Oct 1, 2026 | Rocky Mountain Health Plans PRIME Effective October 1, 2026 | |
| Rocky Mountain Health Plans | Rocky Mountain Medicare Advantage D-SNP | CO | prior auth required | Feb 1, 2025 | Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 | |
| Surest | Surest health plans | All | prior auth under conditions | Cost over $1,000 | Oct 1, 2026 | Prior Authorization Requirements for Surest Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Commercial | All | prior auth under conditions | Notification/prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $1,000. | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Mid-Atlantic Health Plans | All | prior auth under conditions | Prior authorization is required only for DME codes listed with a retail purchase or cumulative rental cost of more than $1,000. | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare West commercial plans | All | prior auth under conditions | Notification/prior authorization is required only for DME codes listed with a retail purchase or cumulative rental cost of more than $1,000. | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare of the River Valley | All | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $1,000. | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 |
| UnitedHealthcare Community Plan | AHCCCS Complete Care (ACC) | AZ | prior auth required | Oct 1, 2026 | Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026 | |
| UnitedHealthcare Community Plan | ALTCS Developmentally Disabled | AZ | prior auth under conditions | Prior authorization is required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026 |
| UnitedHealthcare Community Plan | ALTCS Long Term Care | AZ | prior auth required | Oct 1, 2026 | Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | Indiana Hoosier Care Connect | IN | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Indiana PathWays for Aging (MLTSS) | IN | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for Indiana MLTSS Pathways Effective October 1, 2026 |
| UnitedHealthcare Community Plan | KanCare | KS | prior auth under conditions | Prior authorization is required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for Kansas Medicaid Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Maryland HealthChoice | MD | prior auth under conditions | Prior authorization required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500 Prosthetics are not DME — see orthotics and prosthetics. | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026 |
| UnitedHealthcare Community Plan | Minnesota Metro Medicaid | MN | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME – see orthotics and prosthetics | Oct 1, 2024 | Prior authorization requirements for Minnesota Medicaid Effective October 1, 2024 |
| UnitedHealthcare Community Plan | Mississippi CHIP | MS | prior auth under conditions | Prior authorization is required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500. | Apr 1, 2025 | Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025 |
| UnitedHealthcare Community Plan | MississippiCAN | MS | prior auth under conditions | site of care: outpatient | Apr 1, 2025 | Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025 |
| UnitedHealthcare Community Plan | Missouri Medicaid | MO | prior auth under conditions | Prior authorization required only for the codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME — see Orthotics and Prosthetics. | Jul 1, 2026 | Prior authorization requirements for Missouri Medicaid Effective July 1, 2026 |
| UnitedHealthcare Community Plan | Nebraska Heritage Health | NE | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $750 Prosthetics are not DME – see Orthotics and prosthetics. | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Nebraska Effective July 1, 2026 General Information This list contains prior authorization requirements for participating United |
| UnitedHealthcare Community Plan | New Jersey FamilyCare | NJ | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME – See orthotics and prosthetics | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U |
| UnitedHealthcare Community Plan | New Mexico Turquoise Care | NM | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | Pennsylvania CHIP | PA | prior auth under conditions | Prior authorization required only for the codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME – See orthotics and prosthetics | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026 |
| UnitedHealthcare Community Plan | Pennsylvania Medicaid | PA | prior auth under conditions | Prior authorization required only for the codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME – See orthotics and prosthetics | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026 |
| UnitedHealthcare Community Plan | Rhode Island Medicaid | RI | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME – see Orthotics and prosthetics. | May 1, 2026 | Prior authorization requirements for Rhode Island Medicaid Effective May 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan of Rhode Island h |
| UnitedHealthcare Community Plan | TennCare | TN | prior auth under conditions | Prior authorization is required only for DME codes listed with a retail purchase or a cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Texas CHIP | TX | prior auth under conditions | Prior authorization required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500 Prosthetics are not DME – see Orthotics and prosthetics. | Jan 1, 2015 | Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care |
| UnitedHealthcare Community Plan | Texas STAR | TX | prior auth under conditions | Prior authorization is required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500. | Jan 1, 2015 | Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h |
| UnitedHealthcare Community Plan | Texas STAR Kids | TX | prior auth under conditions | Prior authorization is required only for codes listed with a retail purchase or a cumulative rental cost of more than $500. | Nov 1, 2016 | Prior authorization requirements for STAR Kids Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR Ki |
| UnitedHealthcare Community Plan | Texas STAR+PLUS | TX | prior auth required | Jan 1, 2015 | Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p | |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Florida | FL | prior auth under conditions | Prior authorization required only for the codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME — see orthotics and prosthetics. | Oct 1, 2026 | Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026 |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Hawaii (QUEST Integration) | HI | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME — see Orthotics and prosthetics. | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Hawaii Effective October 1, 2026 |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Kentucky | KY | prior auth under conditions | Cost over $500 | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of New York | NY | prior auth under conditions | Prior authorization is required only for the DME codes listed with a retail purchase or cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026 |
| UnitedHealthcare Community Plan | UnitedHealthcare Connected (Texas MMP) | TX | prior auth under conditions | Prior authorization is required only for a retail purchase or cumulative rental cost of more than $1,000. | Jan 1, 2015 | Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U |
| UnitedHealthcare Community Plan | Virginia Cardinal Care LTSS | VA | prior auth under conditions | Prior authorization required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for Virginia Cardinal Care LTSS Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Virginia Cardinal Care Medicaid | VA | prior auth under conditions | Prior authorization required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for Virginia Cardinal Care Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Washington Apple Health | WA | prior auth under conditions | Prior authorization required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023 |
| UnitedHealthcare Community Plan | Wisconsin BadgerCare Plus and Medicaid SSI | WI | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or a cumulative rental cost of more than $500. | Sep 1, 2026 | Prior authorization requirements for Wisconsin Medicaid Effective September 1, 2026 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community |
E0745 appears in 50 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina, Capital Blue Cross, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Deep Brain Stimulation (0208) | covered if criteria are met | Mar 27, 2026 | payer document |
| Aetna | Diabetic Neuropathy: Selected Treatments (0729) | covered if criteria are met | Feb 24, 2026 | payer document |
| Aetna | Dysphagia Therapy (0625) | not covered | Sep 25, 2025 | payer document |
| Aetna | Eating Disorders (0511) | not covered | Aug 4, 2026 | payer document |
| Aetna | Electrical Stimulation for Chronic Ulcers (0680) Microcurrent therapy; VeinoPlus | not covered | Dec 29, 2025 | payer document |
| Aetna | Facial Nerve Paralysis (0745) Kinesio taping | not covered | Oct 30, 2025 | payer document |
| Aetna | Functional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677) | covered if criteria are met | Sep 10, 2026 | payer document |
| Aetna | Functional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677) | not covered | Sep 10, 2026 | payer document |
| Aetna | Headaches: Invasive Procedures (0707) | not covered | Jul 23, 2026 | payer document |
| Aetna | Huntington's Disease (0614) | not covered | Sep 24, 2026 | payer document |
| Aetna | Levator Syndrome Treatments (0679) | listed, no stance | Oct 15, 2025 | payer document |
| Aetna | Motor Cortex Stimulation (0755) | not covered | Feb 24, 2026 | payer document |
| Aetna | Parkinson's Disease (0307) | not covered | Feb 24, 2026 | payer document |
| Aetna | Peripheral Electrical Nerve Stimulation for Pain (0011) | not covered | Jun 3, 2026 | payer document |
| Aetna | Spasticity Management (0362) | not covered | May 26, 2026 | payer document |
| Aetna | Spinal Cord Stimulation (0194) | covered if criteria are met | Sep 10, 2026 | payer document |
| Aetna | Temporomandibular Disorders (0028) | not covered | Mar 12, 2026 | payer document |
| Aetna | Trigeminal Neuralgia: Treatments (0374) Topical ambroxol, Erenumab, Intravenous ketamine | not covered | Jun 29, 2026 | payer document |
| Aetna | Urinary Incontinence (0223) | covered if criteria are met | Jul 16, 2026 | payer document |
| Anthem | Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES) (DME.00022) | unproven / investigational | Feb 19, 2026 | payer document |
| Anthem | Neuromuscular Stimulation in the Treatment of Muscle Atrophy (CG-DME-03) | covered if criteria are met | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Functional Neuromuscular Electrical Stimulation | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hwave Electrical Stimulation (L.1.01.410) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Interferential Current Stimulation | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Neuromuscular Electrical Stimulation Nmes (L.8.03.401) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Sacral Nerve Neuromodulationstimulation | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Threshold Electrical Stimulation As A Treatment Of Motor Disorders (L.1.01.411) | not covered | payer document | |
| BlueCross BlueShield of South Carolina | Neuromuscular Electrical Stimulation (NMES) (CAM 014) | listed, no stance | Sep 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Sacral Nerve Neuromodulation/Stimulation (CAM 70169) | listed, no stance | Jun 1, 2026 | payer document |
| Capital Blue Cross | H-Wave Electrical Stimulation (MP 6.049) Procedure codes | unproven / investigational | Apr 1, 2026 | payer document |
| Capital Blue Cross | Sacral Nerve Neuromodulation-Stimulation (MP 1.033) Procedure codes | covered if criteria are met | May 1, 2026 | payer document |
| Capital Blue Cross | Threshold Electrical Stimulation as a Treatment of Motor Disorders (MP 6.046) Procedure codes | not covered | Feb 1, 2026 | payer document |
| Centene | Fecal Incontinence Treatments (CP.MP.137) | covered if criteria are met | May 1, 2026 | payer document |
| Centene | Neuromuscular and Peroneal Nerve Electrical Stimulation (NMES) (CP.MP.48) | covered if criteria are met | Apr 1, 2026 | payer document |
| Cigna | Electrical Stimulation Therapy and Devices in a Home Setting (0160) | covered if criteria are met | Sep 15, 2026 | payer document |
| Cigna | Electrical Stimulation Therapy and Devices in a Home Setting (0160) | not covered | Sep 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Surface Electrical Stimulation (MED201.026) | listed, no stance | Jan 1, 2026 | payer document |
| Premera Blue Cross | Electrical Stimulation Devices (1.01.507) | listed, no stance | Feb 10, 2026 | payer document |
| Premera Blue Cross | Sacral Nerve Neuromodulation/Stimulation (7.01.69) | listed, no stance | Jun 8, 2026 | payer document |
| Regence | Functional Neuromuscular Electrical Stimulation (Durable Medical Equipment 83) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (2026T0126UU) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (CS036.Y) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (for Idaho Only) (CS036ID.D) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (for Indiana Only) (CS036IN.13) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (for Kansas Only) (CS036KS.02) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (for Kentucky Only) (CS036KY.12) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (for Nebraska Only) (CS036NE.U) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (for New Jersey Only) (CS036NJ.T) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (for New Mexico Only) (CS036NM.D) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (for Ohio Only) (CS036OH.F) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (for Pennsylvania Only) (CS036PA.W) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation (for Tennessee Only) (CS036TN.Y) | listed, no stance | May 1, 2026 | payer document |
Prior authorization required or conditional in CO, IL, IN, KY, MS, NE, OH, VA, WV.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.