CMS Reconsidering TENS Coverage
The medical necessity of a long-standing Medicare-covered service is being reconsidered. On March 13, the Centers for Medicare & Medicaid Services (CMS) issued a proposed decision memo for transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (CAG-00429N).
According to the memo, the Therapeutic and Technology Assessment Subcommittee of the American Academy of Neurology (AAN) published in 2010 a report finding TENS ineffective for chronic low back pain.
TENS units are usually small, portable battery operated devices which apply an electrical current to the skin for the intent of pain relief. Stimulation parameters such as pulse width, pulse frequency, wave pattern, frequency, and intensity are varied in both clinical usage and the research literature. These parameters are often determined for individual patients by a trial and error method, which requires several sessions of skilled therapy.
According to the National Coverage Determination (NCD) for TENS for Acute Post-Operative Pain (10.2):
The use of Transcutaneous Electrical Nerve Stimulation (TENS) for the relief of acute post-operative pain is covered under Medicare. TENS may be covered whether used as an adjunct to the use of drugs, or as an alternative to drugs, in the treatment of acute pain resulting from surgery.
TENS devices, whether durable or disposable, may be used in furnishing this service. When used for the purpose of treating acute post-operative pain, TENS devices are considered supplies. As such they may be hospital supplies furnished inpatients covered under Part A, or supplies incident to a physician’s service when furnished in connection with surgery done on an outpatient basis, and covered under Part B.
It is expected that TENS, when used for acute post-operative pain, will be necessary for relatively short periods of time, usually 30 days or less. In cases when TENS is used for longer periods, contractors should attempt to ascertain whether TENS is no longer being used for acute pain but rather for chronic pain, in which case the TENS device may be covered as durable medical equipment as described in §280.13.
CPT® codes used to report TENS include:
64550 Application of surface (transuctaneous) neurostimulator
97014 Application of a modality to 1 or more areas; hot or cold packs; electrical stimulation (unattended)
97032 Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes
A public comment period is ongoing until April 12, 2012.
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