Billing: Understand TENS unit requirements Q. When is a TENS unit covered by Medicare?
By Kelly Wolfe
Updated Fri March 22, 2013
A. Medicare pays for the TENS unit in three instances: acute post-operative pain, chronic low back pain when enrolled in a clinical study, and chronic intractable pain other than lower back pain.
Post operative pain
In these cases, it is only covered for 30 days from the date of surgery and will be billed as a rental. You may then bill as a purchase if the physician determines the effectiveness of the TENS unit and shows the patient is likely to benefit from continuous use over a long period of time.
Chronic low back pain when enrolled in a clinical study
Effective for dates of service on or after June 8, 2012, TENS units and related supplies used for chronic low back pain are only covered when the beneficiary is participating in a CMS-approved clinical trial. The patient must also have one of several approved diagnoses: 353.4, 720.2, 721.3, 721.42, 722.10, 722.52, 722.73, 722.83, 722.93, 724.02, 724.03, 724.2, 724.3, 724.4, 738.4, 739.3, 756.11, 756.12, 805.4, 806.4, 846.0, 846.1, 847.2, 953.2.
Make sure you go to clinicaltrials.gov and put the identifier number in the extra narrative field when billing for TENS usage with chronic lower back pain. The good news is that a CMN is not required in these instances. Upon enrollment in the approved study, the TENS unit is eligible for purchase.
Chronic intractable pain other than low back pain
In these cases, the cause of the pain must be a type that is accepted as responding to TENS therapy. The pain must be present for at least three months and you must also show that other appropriate treatment modalities have been tried and failed. The trial period must be monitored by the physician and will be billed as a rental for a maximum of two months. You may then bill for the purchase if the physician determines the effectiveness of the TENS unit and that the patient is likely to benefit from continuous use over a long period of time.
Kelly Wolfe is president of Regency Billing and Consulting. Reach her at kellyw@regency4dme.com or 727-286-6102.
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