Medicare TENS Units Coverage

A TENS is covered for the treatment of beneficiaries with chronic, intractable pain or acute post-operative pain when one of the following coverage criteria, I or II, are met.

  • Acute Post-operative Pain

    TENS is covered for acute post-operative pain. Coverage is limited to 30 days (one month's rental) from the day of 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 than for post-operative pain.
  • Chronic Pain Other than Low Back Pain

    TENS is covered for chronic, intractable pain other than chronic low back pain when all of the following criteria must be 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 at least three months.
    • Other appropriate treatment modalities must have been tried and failed.

  • TENS therapy for chronic pain that does not meet these criteria will be denied as not reasonable and necessary.

TENS therapy for Chronic Low Back Pain (CLBP) will be denied as not reasonable and necessary. 

General Requirements for chronic pain (II)

When used for the treatment of chronic, intractable pain described in section II, the TENS unit must be used by the beneficiary 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. The trial period must be monitored by the treating practitioner to determine the effectiveness of the TENS unit in modulating the pain. For coverage of a purchase, the treating practitioner must determine that the beneficiary is likely to derive significant therapeutic benefit from continuous use of the unit over a long period of time.

A 4-lead TENS unit may be used with either 2 leads or 4 leads, depending on the characteristics of the beneficiary's pain. If it is ordered for use with 4 leads, the medical record must document why 2 leads are insufficient to meet the beneficiary’s needs.

Supplies

Separate allowance will be made for replacement supplies when they are reasonable and necessary and are used with a covered TENS. Usual maximum utilization is:

  • 2 TENS leads - a maximum of one unit of A4595 per month.
  • 4 TENS leads - a maximum of two units of A4595 per month.

If the use of the TENS unit is less than daily, the frequency of billing for the TENS supply code should be reduced proportionally.

Replacement of lead wires (A4557) more often than every 12 months would rarely be reasonable and necessary.

A conductive garment (E0731) used with a TENS unit is rarely reasonable and necessary, but is covered only if all of the following conditions are met:

  • It has been prescribed by the treating practitioner for use in delivering covered TENS treatment.
  • One of the medical indications outlined below is met:
    • The beneficiary 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.
    • The beneficiary 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.
    • The beneficiary has a documented medical condition, such as skin problems, that preclude the application of conventional electrodes, adhesive tapes, and lead wires.
    • The beneficiary requires electrical stimulation beneath a cast to treat chronic intractable pain.

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

  • The beneficiary has a documented skin problem prior to the start of the trial period, and
  • The TENS is reasonable and necessary for the beneficiary.

If the criteria above are not met for E0731, it will be denied as not reasonable and necessary.

Reimbursement for supplies is contingent upon use with a covered TENS unit. Claims for TENS supplies provided when there is no covered TENS unit will be denied as not reasonable and necessary.



HCPCS CODES:

EQUIPMENT

Group 1 Codes

Code

Description

E0720

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, TWO LEAD, LOCALIZED STIMULATION

E0730

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, FOUR OR MORE LEADS, FOR 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)

Group 2 (2 Codes)

Group 2 Paragraph SUPPLIES Group 2 Codes

Code

Description

A4557

LEAD WIRES, (E.G., APNEA MONITOR), PER PAIR

A4595

ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G., TENS, NMES)


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