Transcutaneous Electrical Nerve Stimulators (TENS)

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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.

 

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