Rule 5160-10-15 | DMEPOS: transcutaneous electrical nerve stimulation (TENS) units.
(A) Definitions.
(1) "Accessories" is a collective term that encompasses but is not necessarily limited to the following items:
(a) Adapters;
(b) Clips;
(c) Additional connecting cable for lead wires;
(d) Carrying pouches; and
(e) Covers.
(2) "Supplies" is a collective term that encompasses but is not necessarily limited to the following items:
(a) Electrodes of any type;
(b) Lead wires;
(c) Conductive paste or gel;
(d) Adhesive;
(e) Adhesive remover;
(f) Skin preparation materials;
(g) Batteries; and
(h) Battery charger for rechargeable batteries.
(B) Coverage.
(1) Payment may be made for a TENS unit on a rental/purchase basis.
(2) The default certificate of medical necessity (CMN) form is the ODM 03402, "Certificate of Medical Necessity: Transcutaneous Electrical Nerve Stimulation (TENS) Units" (rev. 7/2018). The CMN includes one of the following statements of need:
(a) For neurogenic pain, the following information:
(i) An attestation that the individual is experiencing intractable, nerve-related pain that has lasted at least six months;
(ii) An appropriate supporting diagnosis; and
(iii) An attestation that the use of a comparable TENS unit for a trial period of at least thirty days produced substantial relief from pain and, if applicable, enabled a significant reduction in medication (e.g., muscle relaxants, narcotics, analgesics); or
(b) For post-operative pain, the following information:
(i) An attestation that treatment lasting no longer than thirty days is needed for acute pain following surgery; and
(ii) The date of surgery.
(3) Rental of a TENS unit to treat neurogenic pain is limited to four months.
(4) Rental of a TENS unit to treat post-operative pain is limited to a single thirty-day period and may not be extended.
(5) Payment may be made for the purchase of a TENS unit to treat neurogenic pain, either after a rental period or without a rental period, if the prescriber attests to the medical necessity of continued treatment.
(6) Separate payment may be made for repair of or supplies for a TENS unit owned by an individual. If the unit was not purchased through medicaid, such payment may be made only if the medical necessity of the unit has been established beforehand. Supplies are to be dispensed only when they are needed, at a frequency not to exceed once per month. The payment made for supplies is an all-inclusive lump sum and does not depend on the number or nature of items in a particular shipment. No separate payment is allowed for individual supply items.
(7) After a TENS unit has been purchased, no separate payment is allowed for accessories.
(C) Constraints and limitations.
(1) A diagnosis of "chronic intractable pain" is not in itself sufficient to warrant coverage.
(2) The warranty period for a purchased TENS unit is two years from the date of delivery.
(3) Payment may be made for the rental or purchase of a used TENS unit only if the particular unit was previously used by the individual for whom it is currently prescribed.
(4) Payment for a TENS unit does not indicate or imply coverage of a conductive TENS garment.
(5) Payment is limited to the maximum amount for a two-lead unit unless the provider obtains and maintains documentation in the individual's file establishing the medical necessity of a four-lead unit.
(D) Claim payment. The lump-sum payment for TENS supplies is twenty-five dollars.
Last updated January 2, 2024 at 8:57 AM
Supplemental Information