Medicare Tens Units
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.
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
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.
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
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
◦The trial period must be monitored by the physician to determine the
effectiveness of the medicare TENS unit in modulating the pain in a
◦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
◦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
◦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
◦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
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.
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
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
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
355.0-355.9 Mononeuritis of lower limb and mononeuritis of
357.2 Polyneuropathy in diabetes (Code first the underlying
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
723.4 Brachial neuritis or radiculitis NOS
724.00 Spinal stenosis, unspecified
724.6 Disorders of Sacrum
729.1 Myalgia and Myositis, unspecified
V45.59, V45.89 Post-surgical states (post-operative pain)
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
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