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Transcutaneous Electrical Nerve Stimulator (TENS)

Revised: 09-14-2016

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Noncovered Services
  • Authorizations
  • Billing
  • Legal References
  • Overview

    A transcutaneous electrical nerve stimulator (TENS) is a device that uses electrical current delivered through electrodes placed on the skin to decrease a recipient’s perception of pain by inhibiting the transmission of pain nerve impulses toward the brain and. stimulating the release of endorphins.

    Eligible Providers

    The following providers may provide TENS units and related supplies:

    Prescribing Providers

    Dispensing Providers

    Clinical nurse specialist

    Federally qualified health centers

    Nurse midwife

    Home health agencies

    Nurse practitioner

    Hospitals

    Physician

    Indian Health Services

    Physician assistant

    Medical suppliers

    Pharmacies

    Rural health clinics

    TPL and Medicare

    Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to assist recipients for whom MHCP is not the primary payer.

    Eligible Recipients

    For eligible recipients with acute pain, MHCP covers rental of a TENS device.

    For eligible recipients with chronic pain other than low back pain, MHCP covers either purchase or rental of a TENS device.

    Covered Services

    Codes: E0720, E0730, E0731, A4557, A4595

    Only TENS devices and conductive garments approved by the Food and Drug Administration (FDA) are covered.

    One set of 2-lead TENS supplies is covered each month of use for recipients using a 2-lead (E0720) TENS device.

    Two sets of 2-lead TENS supplies are covered each month of use for recipients using a 4-lead (E0730) TENS device. TENS supplies necessary for use of the TENS device for one month include, but are not limited to:

  • • Adhesive
  • • Adhesive remover
  • • Batteries
  • • Conductive paste or gel
  • • Electrodes
  • Replacement lead wires are covered no more than twice per year.

    Suppliers must verify the TENS device is still being used before dispensing TENS supplies or lead wires. A new order is not required unless the original order had an end date.

    Noncovered Services

    TENS is not medically necessary for the treatment of chronic low back pain, defined as low back pain from any cause lasting six weeks or more.

    Supplies other than listed above for use with the TENS device are not covered.

    Authorizations

    Refer to the following authorization requirements:

  • • Authorization is required for purchase or rental of the TENS device and the conductive garment
  • • Each month’s rental is one unit. If two months rental is needed, request two units
  • • A TENS device may be medically necessary for acute (non-malignant) post-operative or post-traumatic pain. TENS units will be approved for rental for a period of no more than 60 days following surgery or injury.
  • • Submit a description of the recipient’s operation or trauma and the need for TENS
  • • If the device is required for more than 60 days, the recipient must meet the criteria for chronic pain
  • • A TENS device may be medically necessary for chronic pain conditions other than low back pain that are refractory to other recipient-appropriate methods of treatment. TENS device will be approved for purchase or rental up to 13 months. After 13 months rental, the TENS device is the recipient’s property. Include the following in your request:
  • • A description of the pain and approximate date of onset of pain
  • • Description of prior therapies attempted and recipient’s response
  • • Documentation of any treatments considered but rejected as not appropriate for the recipient
  • • An estimate of the duration of need. Each month rental is one unit. Request one unit for each month needed when requesting rental.
  • • A form fitting conductive garment may be medically necessary for use with a TENS device for some recipients. MHCP will authorize the purchase of form-fitting conductive garments for use with authorized TENS devices if you submit documentation that one or more of the following criteria are met :
  • • The area receiving stimulation is inaccessible to the recipient or caregivers with the use of conventional electrodes, tapes, and lead wires. Include information about the availability of caregivers to assist the recipient
  • • The area receiving stimulation is so large or the areas so numerous conventional electrodes, tapes and lead wires are not practical
  • • The recipient has a skin condition or other medical condition that prevents the application of conventional electrodes, tapes and lead wires
  • All authorization requests

    Submit authorization requests through MN–ITS (authorization request 278). Fax the MN–ITS response with the required documentation and physician’s order to the authorization medical review agent. Document the MN–ITS Authorization Request number assigned on every page of each document.

    For paper authorization, fax or mail the authorization medical review agent the required documentation, physician’s orders and the completed MHCP Authorization Form (DHS-4695-ENG) (PDF).

    Billing

    When billing with an approved authorization:

  • • Use MN–ITS 837P Professional
  • • Report the ordering provider in the Other Provider Types section of the MN–ITS Interactive claim
  • • Use the correct HCPCS code and the modifier(s) NU, RR, KH, KI and KJ as noted on the authorization
  • Legal References

    Minnesota Statutes 256B.0625, subd.31
    Minnesota Rules 9505.0310

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