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Coverage criteria policies

Transcutaneous electrical nerve stimulator (TENS) unit

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for Transcutaneous Electrical Nerve Stimulator (TENS) units.

Coverage

A TENS device is covered as a rental item capping at 6 months, or when the purchase price is met, whichever occurs first. Once the purchase price is reached, this item will be owned by the member.

Electrodes for the TENS unit (A4595) are covered without prior authorization.

TENS units are generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

TENS units are covered for these conditions:

  1. Acute post-operative pain
  2. Acute non-malignant pain
  3. Chronic pain conditions (except for chronic low back pain)
  4. Acute exacerbation of chronic conditions (including chronic low back pain).

Indications / items that are not covered

  1. TENS is not covered for chronic low back pain because studies show TENS is ineffective for that condition.
  2. TENS is not covered for the following conditions where its use is contraindicated:
    1. Members with a cardiac pacemaker/ implanted defibrillator;
    2. Pregnancy;
    3. Inability to use the device;
    4. Chronic pain that is wide-spread and poorly localized including visceral pain and psychogenic pain.
  3. A conductive garment (E0731) is not covered as it is considered a comfort and convenience item and is not the standard acceptable model of electrodes.
  4. TENS is not covered for fibromyalgia because there is insufficient scientific evidence to support its effectiveness for this indication.
  5. The H-wave electrical stimulation device for pain control is not covered because there is insufficient scientific evidence to support its effectiveness for this indication.

Definitions

Transcutaneous electrical nerve stimulator (TENS) unit - a device which decreases the patient’s perception of pain. Electrodes are placed on the surface of the skin and small amounts of electric current are delivered through these electrodes. Patients’ pain perception is decreased because pain nerve impulses are decreased and/or endorphins are released.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

The services associated with these codes do not require prior authorization:

Codes

Description

E0720

Transcutaneous electrical nerve stimulation (TENS) device, 2 lead, localized stimulation

E0730

Transcutaneous electrical nerve stimulation (TENS) device, 4 or more leads, for multiple nerve stimulation

E0731

Form-fitting conductive garment for delivery of TENS or NMES

E1399

Durable medical equipment, miscellaneous, when used to report the H Wave electrical stimulation device

A4595

Electrical stimulator supplies, 2 lead, per month, (e.g., TENS, NMES)

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy contact Member Services at 952-883-7979 or 1-800-233-9645.

Vendor

For in-network benefits to apply, item must be received from a contracted vendor or provider.

References

  1. Beithon, J., Gallenberg, M., Johnson, K., Kildahl, P., Krenik, J., Liebow, M., Swanson, J. Institute for Clinical Systems Improvement. Diagnosis and Treatment of Headache. Updated January 2013.
  2. Dubinsky, R.M., & Miyasaki, J. (2010). Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology (74), 173-76. doi 10.1212/WNL.0b013e3181c918fc
  3. ECRI Institute. (2009). H-wave device stimulation therapy for pain management. Plymouth Meeting, PA: ECRI Institute.
  4. Hayes, Inc. Hayes Medical Technology Directory Report. Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain. Lansdale, PA: Hayes, Inc.; September, 2018..
  5. Hayes, Inc. Hayes Search and Summary. H-Wave (Electronic Waveform Lab, Inc.) for the Treatment of Low Back Pain. Lansdale, PA: Hayes, Inc. June, 2018
  6. Hayes, Inc. Hayes Search and Summary. H-Wave (Electronic Waveform Lab, Inc.) for the Treatment of Lower Extremity Pain. Lansdale, PA: Hayes, Inc.; June, 2018..
  7. Gibson, W., Wand, B. M., & O’Connell, N. E. (2017). Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database of Systematic Reviews, Issue 9, Art. No. CD011976. .
  8. Hooten, M., Thorson, D., Bianco, J., Bonte, B., Clavel Jr., A., Hora, J., Walker, N. Institute for Clinical Systems Improvement. Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management. Updated August 2017.
  9. Johnson, M. I., Claydon, .L. S., Herbison, G. P., Jones, G., Paley, C. A. (2017). Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults. Cochrane Database of Systematic Reviews, Issue 10, Art. No.: CD012172. doi: 10.1002/14651858.CD012172.pub2.
  10. Khadilkar, A., Odebiyi, D. O., Brosseau, L., & Wells, G. A. (2008). Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews, Issue 4, Art. No.: CD003008. doi: 10.1002/14651858.CD003008.pub3.
  11. Savigny, P., Kuntze, S., Watson, P., Underwood, M., Ritchie, G., Cotterell, M., … Walsh D. (2009). Low back pain: early management of persistent non-specific low back pain. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners.

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Policy activity

  • 01/01/1994 - Date of origin
  • 06/01/2019 - Effective date
Review date
  • 12/2018
Revision date
  • 05/23/2019

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