Coverage

• Transcutaneous Electrical Nerve Stimulators (TENS) Local Coverage Determination (LCD) and Policy Article [PDF]
• TENS for Acute Post-Operative Pain (10.2) National Coverage Determination (NCD)
• TENS for Chronic Low Back Pain (CLBP) (160.27) NCD
• Supplies Used in the Delivery of TENS and Neuromuscular Electrical Stimulation (NMES) (160.13) NCD
• TENS (280.13) NCD

Documentation

• Clinician Letter - Medical Records [PDF] - Letter may be sent to clinicians to help obtain documentation
• CMS 848 CMN - TENS Certificate of Medical Necessity (CMN)
• TENS Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation

Reviews/Audits

• Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review

Tips

Topic	Details
A9270 - Non-covered item or service	The Food and Drug Administration (FDA) has several product classifications for Transcutaneous Electrical Nerve Stimulators (TENS) devices, one of which is designated for TENS devices that may be sold over-the-counter (OTC). OTC TENS are identified with FDA product code NUH. OTC TENS are not considered durable medical equipment (DME). OTC TENS must be coded using HCPCS code: A9270 - Non-covered item or service
KG Modifier	Modifier must be billed with all TENS supplies (A4595 and A4557) for dates of service on/after January 1, 2018. Does not apply to supplies used with Neuromuscular Electrical Stimulation (NMES)

 

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 20
• CMS IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 5
• CMS Medicare Learning Network (MLN) Matters (MM)7836 - Effective for claims with dates of service on/after 06/08/12, CMS believes  evidence is inadequate to support coverage of TENS for CLBP as reasonable and necessary. Thus, effective for claims with dates of service on/after 06/08/12, Medicare will only allow coverage of TENS for CLBP defined for this decision as pain for 3 months or longer and not a manifestation of a clearly defined and generally recognizable primary disease entity, when patient is enrolled in an approved clinical study under coverage with evidence development (CED). Note: CED coverage expires three years from the effective date of this CR, 06/08/15