Article Detail - JD DME
RETIRED - Coverage Reminder - Transcutaneous Electrical Nerve Stimulators (TENS) Used For Chronic Low Back Pain
Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.
Posted October 19, 2012
Effective for dates of service on or after June 08, 2012 TENS and related supplies used for chronic low back pain (CLBP) are only covered when the beneficiary is a participant in a CMS-approved clinical trial and has one or more required diagnoses. All other claims for TENS and related supplies used for CLBP will be denied as not reasonable and necessary. Only the following diagnoses (ICD-9) will justify coverage:
- 353.4 Lumbosacral root lesions, not elsewhere classified
- 720.2 Sacroiliitis, not elsewhere classified
- 721.3 Lumbosacral spondylosis without myelopathy
- 721.42 Thoracic or lumbar spondylosis with myelopathy - lumbar region
- 722.10 Lumbar intervertebral disc without myelopathy
- 722.52 Lumbosacral intervertebral disc
- 722.73 Intervertebral disc disorder myelopathy - lumbar region
- 722.83 Post laminectomy syndrome - lumbar region
- 722.93 Other and unspecified disc disorders, lumbar region
- 724.02 Spinal stenosis, lumbar region without neurogenic claudication
- 724.03 Spinal stenosis, lumbar region with neurogenic claudication
- 724.2 Lumbago
- 724.3 Sciatica
- 724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified, radicular syndrome of lower extremities
- 738.4 Acquired spondylolysthesis
- 739.3 Non-allopathetic lesions NEC (not elsewhere classified) - lumbar region
- 756.11 Spondylosysis, lumbosacral region
- 756.12 Spondylolisthesis
- 805.4 Fracture of vertebral column without mention of spinal cord injury, lumbar, closed
- 806.4 Fracture of vertebral column with mention of spinal cord injury, lumbar, closed
- 846.0 Sprains and strains of sacroiliac region - lumbosacral (joint) (ligament)
- 846.1 Sprains and strains of sacroiliac ligament
- 847.2 Sprains and strains of other and unspecified parts of back, lumbar
- 953.2 Injury to nerve roots and spinal plexus, lumbar root
The beneficiary must be enrolled in an approved clinical study that meets all of the requirements set out in NCD §160.27 (CMS Internet Only Manual 100-3, Chapter 1). Refer to the DOCUMENTATION REQUIREMENTS and APPENDICES sections of TENS LCD for additional information about approved clinical studies.
Coverage requirements for TENS and related supplies used for non-CLBP remain unchanged. Refer to the INDICATIONS AND LIMITATIONS OF COVERAGE AND/OR MEDICAL NECESSITY section of LCD for additional information about coverage for non-CLBP conditions.
Information concerning documentation required for TENS used for CLBP may be found in the LCD. Also Refer to the Supplier Manual for additional information about general documentation requirements.
Last Updated Thu, 10 Jan 2019 12:52:48 +0000