Iontophoresis may be considered medically necessary to administer local anesthesia prior to a venipuncture or dematologic procedure.
Iontophoresis of fentanyl may be considered medically necessary for the short-term (i.e., less than 24 hours) management of acute postoperative pain in adult patients requiring opioid analgesia during hospitalization.
Iontophoresis as a transdermal drug delivery technique for other medical indications is considered investigational.
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member’s specific benefit plan language.
Code Number Description
CPT – 97033 Application of a modality to one or more areas; iontophoresis, each 15 minutes
ICD- 99.27 Iontophoresis – Not reimbursed code
8/2001: Approved Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
5/1/2002: Type of Service and Place of Service deleted
5/29/2002: Code Reference section updated, ICD-9 diagnosis code 780.8 added non-covered table
7/2003: Reviewed by MPAC, no changes, FEP coverage updated, Sources updated
11/19/2004: Code Reference section reviewed, CPT code 97033 description revised and “Note: Some providers may code iontophoresis using CPT code 97039, unlisted modality. This is inappropriate.” deleted, non-covered table deleted, ICD-9 diagnosis code 780.8 deleted non-covered codes
10/17/2006: Policy reviewed, updated to match BCBSA policy
10/25/2006: Code Reference section updated. ICD-9 Diagnosis Codes 726.32, 726.71, 728.71 deleted from policy
10/01/2007: Policy reviewed. Added iontophoresis of fentanyl may be considered medically necessary for the short-term (i.e., less than 24 hours) management of acute postoperative pain in adult patients requiring opioid analgesia during hospitalization
11/15/2007: Policy revisions approved by MPAC
10/7/2008: Policy reviewed, no changes