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Effective January 1, 2015, a new medical policy regarding
transcutaneous electrical nerve stimulators (TENS) will outline medical
necessity criteria and what is considered experimental/investigational.
About the TENS device
A TENS is a nonpharmacologic and noninvasive treatment for symptomatic pain
relief. The battery-operated device utilizes electrical current delivered
through electrodes placed on the surface of the individual?s skin to decrease
the perception of pain. It may be applied in a variety of settings such as the
individual?s home, a professional provider?s office, or an outpatient clinic.
If the medical necessity criteria are met, as outlined in the new policy,
payment for TENS will be made under the benefits provided for durable medical
equipment.
New policy details
Please note the following coverage position under the new policy:
- Acute post-operative pain.
A TENS device is considered
medically necessary for individuals with acute post-operative
pain.
- Chronic pain ? experimental/investigational.
The use of a
TENS device is considered experimental/investigational for the treatment of
chronic pain (i.e., present for at least three months) when the presumed
etiology of the pain is a type that is not accepted as responding to the TENS
device, which includes the following:
- - visceral abdominal pain;
- - pelvic pain;
- - temporomandibular joint (TMJ) pain;
- - headache disorder pain (i.e., migraine, tension-type headache,
cluster headache and other trigeminal autonomic cephalgias, and
other primary headaches);
- - low back pain that is not a manifestation of a clearly defined
and generally recognizable primary disease entity.
Note: For Medicare Advantage HMO members, the Centers for
Medicare & Medicaid Services will allow TENS coverage for chronic low back
pain only when the individual is enrolled in an approved clinical study meeting
specified requirements.
- Chronic pain ? medically necessary. For the treatment of
other types of chronic pain (i.e., present for at least three months), a 30 -
60 day trial of a TENS device is considered medically necessary when the
presumed etiology of the pain is a type that is accepted as responding to TENS
therapy and other appropriate treatment modalities (e.g., physical therapy,
pharmacotherapy) have been tried and failed.
If a TENS device is effective in modulating pain after a 30 — 60 day
trial rental period, the supplier can submit for purchase of the TENS unit and
must provide documentation to support compliance and effective treatment.
During the 30 — 60 day trial period, reimbursement for the TENS device
will only be made as a rental. The rental cost of the TENS device is included
in the purchase price of the TENS device.
All supplies (e.g., electrodes, lead wires, batteries) are included during the
rental period and will not be reimbursed separately. Furthermore, replacement
supplies, when used with a medically necessary TENS device, are considered
medically necessary for the specified maximum utilization time frame as
outlined in the policy.
For more information
To review our position on Transcutaneous Electrical Nerve Stimulators (TENS)
and Associated Supplies, refer to the Policy Notifications on our Medical
Policy Portal after December 1, 2014. Select Accept and Go to Medical
Policy Online, and then select the Commercial or Medicare
Advantage tab from the top of the page, depending on the version of the
Notification you?d like to view. Then type the policy name or number in the
Search field:
- Commercial:
#05.00.74: Transcutaneous Electrical
Nerve Stimulators (TENS) and Associated Supplies;
- Medicare Advantage:
#MA05.006: Transcutaneous
Electrical Nerve Stimulators (TENS) and Associated Supplies.
You can also view policy activity through the NaviNet
® web
portal by selecting the
Reference Tools transaction, then
Medical
Policy.
Please contact your Network Coordinator if you have any questions on the new
TENS policy.
NaviNet® is a registered trademark of
NaviNet, Inc., an independent company.
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