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.

Please contact your Network Coordinator if you have any questions on the new TENS policy.

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