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Transcutaneous Electrical Nerve Stimulators (TENS)

Coverage

Documentation

Document Type Description
CMS 848 CMN [PDF] TENS Certificate of Medical Necessity (CMN)
Physician Letter [PDF] Suppliers may use this letter written by DME Medical Directors to assist in obtaining documentation from physicians
Documentation Checklist [PDF] Suppliers may use this checklist to ensure all of required documentation is gathered

 

References

Reference Title Description
CMS Internet Only Manual (IOM) This link will take you to an external website. Publication 100-04, Medicare Claims Processing Manual, Chapter 20
CMS IOM This link will take you to an external website. Publication 100-08, Medicare Program Integrity Manual, Chapter 5
MLN Matters 7836 Revised This link will take you to an external website. Effective for claims with dates of service on or after June 8, 2012, CMS believes the evidence is inadequate to support coverage of TENS for CLBP as reasonable and necessary. Thus, effective for claims with dates of service on and after June 8, 2012, 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 the 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, June 8, 2015.

 

Reviews/Audits

Review Type Description
Medical Review View notifications and findings of pre and post claim reviews completed by Noridian Medical Review Staff

 

Reminder

Topic Reminder
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

 

Last Updated May 31, 2017