TENS documentation needs (ACA, Face to Face visit is required)
The following qualification criteria need to be documented in the patients’ medical record notes to qualify for the prescribed equipment. Note: Face to face and justification notes are valid for six months.
All of the following need to be sufficiently documented to support the need for the prescribed equipment, depending on the need.
A. Acute Post-operative Pain
Document the procedure/cause of the acute post-operative pain. Note: Coverage is limited to 30 days from the day of surgery.
Coverage is diagnosis specific. Documentation supporting one or more of the approved ICD 10 codes must be documented in the patients’ medical record. See: LCD for Transcutaneous Electric Nerve Stimulator (TENS) for complete listing of acceptable ICD10 codes.
B. 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: Note: Coverage is not diagnosis specific
- The presumed etiology of the pain must be a type that is accepted as responding to TENS therapy. Examples of non-covered conditions (not all-inclusive):
- visceral abdominal pain
- pelvic pain
- temporomandibular joint (TMJ) pain
- Documents the duration of the pain. Note: Pain must have been present for at least three months
- Document what other treatment modalities have been tried and failed.
Note: When used for the treatment in section II, the TENS unit must be used by the beneficiary on a trial basis for a minimum of one month (30 days), The trial period must be monitored by the physician to determine the effectiveness of the TENS unit in modulating the pain. For use beyond 30 days the physician must document that the patient is likely to derive significant therapeutic benefit from continuous use of the unit over a long period of time.
C. Chronic Low Back Pain (CLBP)
TENS therapy for CLBP is only covered when all of the following criteria are met:
- Document the beneficiary’s diagnosis code(s) that Supports Medical Necessity. See code section below.
- Document if the patient is enrolled in an approved clinical study that meets all of the requirements of NCD §160.27 (CMS Internet Only Manual 100-03, Chapter 1). TENS used for CLBP as described in section III does not require a trial rental period or an assessment of effectiveness by the treating physician. Upon the beneficiary’s enrollment into an approved study, the TENS is eligible for purchase. Note: currently there are no clinical studies in progress.
Note: TENS used for CLBP as described in section III does not require a trial rental period or an assessment of effectiveness by the treating physician upon the patient’s enrollment into an approved study.
4-lead TENS Unit (If the patient requires a 4 lead unit)
- Document why 2 leads are insufficient to meet the beneficiary’s needs.
Diagnosis: See LCD (Local coverage determination) at CGSMedicare.com for any additional qualifying information questions, diagnosis codes and descriptions
|Medicare approved detailed equipment descriptions for TENS
Patient notes/justification – Must be documented using your normal dictation process. Letter of medical necessity, notes wrote on letterhead or prescriptions are not valid.
Prescription/order requirements– Must contain Patient’s name, date of the order and Start date, detailed equipment description (See above), Physician’s NPI (national provider number), signature of the ordering physician and a signature date.