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Billing Reminders: Transcutaneous Electrical Nerve Stimulators and Supplies

National Government Services, the Jurisdiction B DME MAC has recently seen an increase in inquiries related to the coverage and billing of TENS units and supplies. We’ve also seen a significant increase in the number of redeterminations on claims for TENS units and supplies.

Suppliers are reminded that a TENS is covered for the treatment of patients with chronic, intractable pain or acute post-operative pain who meet the coverage criteria listed in the TENS LCD and related policy article.

TENS Rental

  • Acute Post-Operative Pain—When a TENS unit is used for acute post-operative pain, the medical necessity is usually limited to 30 days from the day of surgery. Payment will be made only as a rental. A TENS unit will be denied as not medically necessary for acute pain (less than three months duration) other than post-operative pain.
  • Chronic Pain—When used for the treatment of chronic, intractable pain, the TENS unit must be used by the 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. The trial period must be monitored by the physician to determine the effectiveness of the TENS unit in modulating the pain.

Note: A CMN is not required for the rental of a TENS unit.

TENS Purchase

In order for Medicare to cover the purchase of a TENS unit, the physician must determine that the patient is likely to derive significant therapeutic benefit from continuous use of the unit over a long period of time. The physician's records must document a reevaluation of the patient at the end of the trial period, must indicate how often the patient used the TENS unit, the typical duration of use each time, and the results.

A CMN CMS-848 TENS form is required for the purchase of a TENS unit.

TENS Unit CMN Completion

Section A – Certification Type/Date

The CMN completed for the purchase of a TENS unit would be an Initial CMN. The patient is required to have at minimum a 30-day trial period, following the trial period the treating physician must reevaluate the patient to determine that the patient is likely to derive significant therapeutic benefit from continuous use of the TENS unit over a long period of time. The initial date reported would be on or after the treating physician re-evaluates the patient and determines they meet the coverage criteria to allow for the purchase of the TENS unit.

Example

TENS trial begins on 3/15/12 and the treating physician re-evaluates the patient on 4/25/12 and determines they are likely to derive significant therapeutic benefit from continuous use of the TENS unit over a long period of time.

  • Date of Service 3/15/12 is billed as E0720RR – No CMN required
  • Date of Service 4/25/12 is billed as E0720NU – Initial date on CMN should be 4/25/12

TENS Supplies and Accessories

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 one month’s supply of supplies.

Code Description
A4557 LEAD WIRES, (E.G., APNEA MONITOR), PER PAIR
A4595 ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G. TENS, NMES)

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.

  • Two TENS leads – maximum 1 unit of A4595 per month
  • Four TENS leads – maximum 2 units of A4595 per month

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 medically necessary.

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

Additional TENS supplies and Accessories

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 unit.

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.

Conductive Garment (E0731)

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

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

Use of a conductive garment with a purchased TENS unit is rarely reasonable and necessary but may be covered if all of the following conditions are met:

  • It has been prescribed by a physician for use in delivering covered TENS treatment; and
  • 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; or
    • The beneficiary has a documented medical condition, such as skin problems, that preclude the application of conventional electrodes, adhesive tapes, and lead wires; or
    • The beneficiary requires electrical stimulation beneath a cast to treat chronic intractable pain.

Medicare requires that supplies and accessories only be provided for equipment that meets the existing coverage criteria for the base item. Medicare will cover supplies and accessories needed for beneficiary-owned equipment that was not paid for by Medicare fee-for-service (FFS)—i.e., only equipment that was paid by other insurance or by the beneficiary. For supplies and accessories used with that equipment, all of the following information must be submitted with the initial claim in Item 19 on the CMS-1500 claim form or in the 2400.NTE segment for electronic claims:

  • HCPCS code of base equipment
  • A notation that this equipment is beneficiary-owned
  • Date the patient obtained the equipment

Claims for supplies and accessories must include all three pieces of information listed above. Claims lacking any one of the above elements will be rejected with ANSI code PR-16. When PR-16 is received for this reason, the supplier must resubmit the claim with the correct information in the NTE (note) segment.

Replacement TENS Units

Medicare will allow for the replacement of a TENS unit (E0720, E0730) when it has been in continuous use for 5-years, or in cases of loss, theft, or irreparable damage. Irreparable damage refers to a specific accident or to a natural disaster (e.g., fire, flood, etc.).

A new trial period is not required and is not payable when replacing a TENS unit. When the claim for the replacement TENS unit is submitted, the RA modifier to the HCPCS code for the TENS unit, along with any other applicable modifiers (i.e., NUKX). Also, suppliers must provide the reason for the replacement in Item 19 of the CMS-1500 claim form or in the 2400 NTE segment for electronic claims.

Billing Reminders: Transcutaneous Electrical Nerve Stimulators and Supplies
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