Transcutaneous Electrical Nerve Stimulators (TENS) - JA DME

Transcutaneous Electrical Nerve Stimulators (TENS)

Standard Documentation Requirements for All Claims Submitted to DME MACs
Clinician Checklist Transcutaneous Electrical Nerve Stimulators (TENS) [PDF] - Checklist to assist clinicians with coverage and documentation requirements
Clinician Checklist Transcutaneous Electrical Nerve Stimulators (TENS) Conductive Garment [PDF] - Checklist to assist clinicians with coverage and documentation requirements
Clinician Letter - Medical Records [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
CMS 848 CMN - TENS Certificate of Medical Necessity (CMN)
TENS Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation

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

Topic	Details
Coverage Criteria	Covered for treatment of beneficiaries with chronic, intractable pain or acute post-operative pain Acute Post-operative Pain - when one of the following coverage criteria are met. Coverage is limited to 30 days (one month’s rental) from the day of the surgery. Payment will be made only as a rental. A TENS unit will be denied as not reasonable and necessary for acute pain (less than three months duration) other that for post-operative pain. Chronic Pain Other than Low Back Pain - when all the following criteria is met: The presumed etiology of the pain must be a type that is accepted as responding to TENS therapy. Examples of conditions for which TENS therapy is not considered to be reasonable and necessary are (not all-inclusive): Headache, Visceral abdominal pain, Pelvic pain, Temporomandibular joint (TMJ) pain The pain must have been present for a least three months Other appropriate treatment modalities must have been tried and failed. TENS therapy for chronic pain that does not meet these criteria will be denied as not reasonable and necessary.

Topic

Details

Coverage Criteria

Covered for treatment of beneficiaries with chronic, intractable pain or acute post-operative pain

Acute Post-operative Pain - when one of the following coverage criteria are met.
- Coverage is limited to 30 days (one month’s rental) from the day of the surgery. Payment will be made only as a rental.
- A TENS unit will be denied as not reasonable and necessary for acute pain (less than three months duration) other that for post-operative pain.
Chronic Pain Other than Low Back Pain - when all the following criteria is met:
- The presumed etiology of the pain must be a type that is accepted as responding to TENS therapy. Examples of conditions for which TENS therapy is not considered to be reasonable and necessary are (not all-inclusive):
  - Headache, Visceral abdominal pain, Pelvic pain, Temporomandibular joint (TMJ) pain
- The pain must have been present for a least three months
- Other appropriate treatment modalities must have been tried and failed.

TENS therapy for chronic pain that does not meet these criteria will be denied as not reasonable and necessary.

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 Change Request (CR) 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

Last Updated Wed, 12 Oct 2022 16:54:51 +0000