Transcutaneous Electrical Nerve Stimulators (TENS) - JD DME
Transcutaneous Electrical Nerve Stimulators (TENS)
Coverage
- TENS (280.13) National Coverage Determination (NCD)
- TENS for Acute Post-Operative Pain (10.2) 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
- Transcutaneous Electrical Nerve Stimulators (TENS) Local Coverage Determination (LCD)
- Transcutaneous Electrical Nerve Stimulators (TENS) Policy Article
Documentation
- 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
- 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
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.
- 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):
TENS therapy for chronic pain that does not meet these criteria will be denied as not reasonable and necessary.
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 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 Sep 11 , 2024
