Medicare Tens Units

Medicare TENS units information
Description of Service/Assessment/Background Information Regarding Medicare TENS units:

A medicare covered Transcutaneous Electrical Nerve Stimulator [TENS E0720, E0730] is a device which utilizes electrical current delivered through electrodes placed on the surface of the skin to decrease the medicare patient's perception of pain by inhibiting the transmission of afferent pain nerve impulses and/or stimulating the release of endorphins. A medicare TENS unit must be distinguished from other electrical stimulators (e.g., neuromuscular stimulators) which are used to directly stimulate muscles and/or motor nerves.

Acute Pain: Acute pain for medicare patients lasts or is anticipated to last a short time, typically less than one month. Acute pain is often associated with anxiety and with hyperactivity of the sympathetic nervous system. (e.g., tachycardia increased respiratory rate and blood pressure, diaphoresis, dilated pupils).

Chronic pain: Pain is considered chronic if its results from a chronic pathological process, if it has recurred periodically over months or years, or if it persists longer than expected after an illness or injury. Typically, chronic pain is considered chronic if it has persisted for 6 months or more on medicare patients. Common chronic pain syndromes include: lower back pain
(also called lumbar pain or low back pain), headache, myofascial pain, fibromyalgia, neuropathic pain, phantom limb pain, and central pain syndrome. All these conditions exist in medicare patients which would benefit from a medicare TENS unit which is covered by medicare.

Policy and Rationale:
Most health plans and medicare will cover medicare Transcutaneous Electrical Nerve Stimulator (TENS) therapy used in the treatment of Pain Management for Medicare Members who meet the below criteria outlined by medicare for medicare TENS units

Treatment/Application Guidelines:
Medicare Transcutaneous Electrical Nerve Stimulator (TENS) therapy is covered for the treatment of medicare patients with chronic, intractable pain,low back pain, neck pain, shoulder pain, knee pain, hand pain, wrist pain, elbow pain, head pain, foot pain  or acute post-operative pain, who meet one of the following coverage criteria for medicare TENS units:

1.Acute post-operative pain:
◦Medical necessity for a medicare TENS unit is usually limited to 30 days from the day of surgery performed on a medicare patient.
◦Requests for treatment beyond the first 30 days is determined by on each individual medicare patient consideration based upon supportive documentation provided by attending physician.
◦Payment for the medicare TENS unit will be made only as a rental.
◦Medicare TENS units used as therapy is not considered to be medically necessary for acute pain in medicare patients (less than three months duration) other than postoperative pain in medicare patients who need or use medicare TENS units.

2.Chronic, intractable pain:
◦Medicare TENS unit must be used by the medicare patient on a trial basis for a minimum of one month (30 days), but not to exceed two months. The trial period will be paid as a rental on the medicare TENS units.
◦The trial period must be monitored by the physician to determine the effectiveness of the medicare TENS unit in modulating the pain in a medicare patient.
◦For coverage of the purchase of a medicare TENS unit, the physician must determine that the medicare patient is likely to derive significant therapeutic benefit from the continuous use of the medicare TENS unit over a long period of time. The physician's records must document a re-evaluation of the medicare patient at the end of the trial period. Records must indicate how often the medicare patient used the medicare TENS unit, the typical duration of use each time, and the results.
 
3.Chronic pain:
◦The medical record must document the location of the pain of the medicare patient who needs a medicare TENS unit, the duration of time the medicare patient has had the pain, and the presumed etiology of the pain.
◦The pain must have been present for at least three months.
◦Other appropriate treatment modalities must have been tried and failed on medicare patient.
◦The medical record must document what treatment modalities have been used (including the name and dosage of medication), the length of time that each type of treatment was used, and the results on the medicare patient.
◦The presumed etiology of the pain must be a type that is accepted as responding to medicare TENS units therapy on medicare patient.

4. Medicare TENS units come with either 2 or 4 lead wired and self-adhesive electrodes. A 4 lead medicare TENS unit may be used with either 2 leads or 4 leads, depending on the characteristics of the medicare patient's pain. Usually, the use of a medicare TENS unit with 2 leads is sufficient to provide pain relief while using a medicare approved TENS unit. However, if a medicare TENS unit is ordered for use with 4 leads, the medical records must document why 2 leads are insufficient to meet the medicare patient's needs.
 
A medicare TENS conductive garment (E0731) used with a medicare covered TENS unit is rarely medically necessary for medicare patients, but may be covered if all of the following conditions are met:

1.It has been prescribed by a physician for use in delivering covered TENS treatment for medicare patient; and

2.One of the medical indications outlined below for a medicare covered TENS unit is met:

a. The medicare patient cannot manage without the conductive garment because there is such a large area or so many sites to be stimulated and the stimulation would have to be delivered so frequently that it is not feasible to use conventional electrodes, adhesive tapes, and lead wires; or

b. The medicare patient cannot manage without the conductive garment for the treatment of chronic intractable pain because the areas or sites to be stimulated are inaccessible with the use of conventional electrodes, adhesive tapes, and lead wires; or

c. The medicare patient has a documented medical condition, such as skin problems, that preclude the application of conventional electrodes, adhesive tapes, and lead wires; or

d. The medicare patient requires electrical stimulation beneath a cast to treat chronic intractable pain.

A TENS conductive garment is not covered for use with a TENS device during the trial period unless:

1.The medicare patient has a documented skin problem prior to the start of the trial period; and

2.The item is medically necessary for the medicare patient.

Payment Guidelines:
During the rental of a TENS unit, supplies for the unit are included in the rental allowance; there is no additional allowance for electrodes, lead wires, batteries, etc. If a TENS unit (E0720 or E0730) is purchased, the allowance includes lead wires and one month's supply of electrodes, conductive paste or gel (if needed), and batteries.

Separate allowance will be made for replacement supplies when they are medically necessary and are used with a TENS unit that has been purchased and/or approved by Medicare. If two (2) TENS leads are medically necessary, then a maximum of one unit of Code A4595 would be allowed per month; if four (4) TENS leads are necessary, a maximum of two units per month would be allowed. If the use of the TENS unit is less than daily, the frequency of billing for the TENS supply code should be reduced proportionally.

There should be no billing and there will be no separate allowance for replacement electrodes (A4556), conductive paste or gel (A4558), replacement batteries (A4630), or a battery charger used with a TENS unit.

Replacement of lead wires (A4557) will be covered when they are inoperative due to damage and the TENS unit is still medically necessary. Replacement more often than every 12 months would rarely be medically necessary.

Other supplies, including but not limited to the following, will not be separately allowed: adapters (snap, banana, alligator, tab, button, clip), belt clips, adhesive remover, additional connecting cable for lead wires, carrying pouches, or covers.

Applicable CPT Code
64550  Application of surface (transcutaneous) neurostimulator

Applicable HCPCS Codes
E0720 Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation
E0730 Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, larger area/multiple nerve stimulation
E0731 Form fitting conductive garment for delivery of TENS or NMES (with conductive fibers separated from the patient’s skin by layers of fabric)
E0762 Transcutaneous electrical joint stimulation device system, includes all accessories

Applicable ICD-9 Codes
053.19 Herpes Zoster, with other nervous system complications
337.20-337.29  Reflex sympathetic dystrophy
353.8  Other nerve root and plexus disorders
354.0-354.9  Mononeutitis of upper limb and mononeuritis multiplex
355.0-355.9  Mononeuritis of lower limb and mononeuritis of unspecified site.  
357.2  Polyneuropathy in diabetes (Code first the underlying disease [250.60-250.63])
357.3  Polyneuropathy in malignant disease (Code first the underlying disease [140.0-208.9])
357.4  Polyneuropathy in other diseases classified elsewhere (Code first the underlying disease [HIV -042])
715.00- 715.98 Osteoarthrosis and allied disorders  
721.90 - 721.91  Spondylosis of unspecified site
722.0-722.93  Intervertebral disc disorders, with or without myelopathy  
723.4  Brachial neuritis or radiculitis NOS
724.00 Spinal stenosis, unspecified
724.2  Lumbago
724.3  Sciatica
724.6  Disorders of Sacrum
729.1  Myalgia and Myositis, unspecified  
V45.59, V45.89  Post-surgical states (post-operative pain)

References:
1.Empire Medicare Services - New York. "Transcutaneous Electrical Nerve Stimulation (TENS)". Policy number: PM002G01. Effective November 29, 1999. Retrieved July 14, 2004.
2.Tricenturion (Region A DMERC). "Transcutaneous Electrical Nerve Stimulators." Policy number TENS20030401. Effective April 1, 2003. Retrieved July 14, 2004.
3.Medicare Coverage Issues Manual. Section 60-20. "Transcutaneous Electrical Nerve Stimulators (TENS)". Retrieved July 14, 2004.
4.Medicare Coverage Issues Manual. Section 45-19. "Transcutaneous Electrical Nerve Stimulation (TENS) for Acute Postoperative Pain". Retrieved July 14. 2004.
5.Medicare Coverage Issues Manual. Section 45-25. "Supplies used in the Delivery of Transcutaneous Electrical Nerve Stimulation (TENS) and Neuromuscular Electrical Stimulation (NMES)". Retrieved July 14, 2004.
6.Medicare Coverage Issues Manual. Section 35-46. "Assessing Patient's Suitability for Electrical Nerve Stimulation Therapy". Retrieved July 14, 2004.
7.Centers for Medicare & Medicaid Services (CMS). 2007 Level II Alpha-Numeric Health Care Procedure Coding System (HCPCS) File. Rev. 11/17/06. Retrieved 11/21/06.
Effective Date: January 1, 2007
*some information above has been modified or changed in regards to the reference number associated with the statements