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Coverage Reminder – Transcutaneous Electrical Nerve Stimulators Used For Chronic Low Back Pain

Transcutaneous electrical nerve stimulators (TENS) and related supplies  used for chronic low-back pain (CLBP) are only covered when the following criteria are met:

  • The beneficiary has one of the Group 1 diagnosis codes listed in the LCD for Transcutaneous Electrical Nerve Stimulators (TENS) (L33802) within the section titled ICD-10 Codes that Support Medical Necessity.
  • The beneficiary is enrolled in an approved clinical study that meets all of the requirements set out in CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Section 160.27.

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

Currently, no clinical studies involving TENS for the treatment of CLBP have been approved by CMS. Therefore, claims for TENS units and related supplies used for chronic low-back pain (CLBP) will be denied as not reasonable and necessary.

Coverage requirements for TENS and related supplies used for non-CLBP are outlined in the Coverage Indications, Limitations, and/or Medical Necessity section of LCD for TENS (L33802). The documentation requirements for TENS units are found in the General Information/Documentation Requirements section of the LCD.

For general documentation requirements, refer to the Jurisdiction B Supplier Manual.

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Coverage Reminder – Transcutaneous Electrical Nerve Stimulators Used For Chronic Low Back Pain
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