Transcutaneous Electrical Nerve Stimulator (TENS)

Revised: March 9, 2026

· Overview

· Eligible Providers

· TPL and Medicare

· Eligible Members

· Covered Services

· Noncovered Services

· Authorizations

· Billing

· Legal References

Overview

A transcutaneous electrical nerve stimulator (TENS) is a portable device that uses electrodes placed on the member’s skin to generate electrical current to decrease perception of pain. Electrodes prevent the transmission of sensory pain nerve impulses to the brain and stimulate the release of endorphins.

Eligible Providers

The following may provide TENS units and supplies:

· Federally qualified health centers

· Home health agencies

· Hospitals

· Indian Health Services

· Medical suppliers

· Pharmacies

· Rural health clinics

TPL and Medicare
Providers must meet any provider criteria, including accreditation, for third-party insurance or for Medicare to assist members for whom Minnesota Health Care Programs (MHCP) is not the primary payer.

MHCP quantity limits and thresholds apply to all members unless only Medicare coinsurance or deductible is requested.

Refer to the Medicare and Other Insurance section of the MHCP Provider Manual for more information.

Eligible Members

TENS devices are covered for Medical Assistance and MinnesotaCare members who meet the criteria described under the Covered Services heading.

Transcutaneous tibial nerve stimulators for overactive bladder, urinary urgency, or related incontinent diagnoses are addressed in the Incontinence Products section of the MHCP Provider Manual. Electrical stimulation devices for treatment of musculoskeletal dysfunction, pain or disease are addressed in the Electrical Stimulation Devices section of the MHCP Provider Manual.

Covered Services

Codes: E0720, E0730, E0731, A4557, A4595
MHCP covers the following equipment:

· TENS device, two-lead (E0720)

· TENS device, four or more leads (E0730)

· Form-fitting conductive garment for delivery of TENS or NMES (E0731)

· Lead wires (A4557)

· Two-lead TENS supplies (A4595)

TENS devices are covered for members who require electrical stimulation for acute pain and for chronic pain other than chronic low back pain. TENS devices are covered as an adjunct to treatment during acute post-operative pain following surgery. TENS devices are covered for chronic pain that has not responded to conservative treatments.

MHCP covers TENS devices as rentals for up to two months during post-operative periods for acute pain. The rental period must be supervised by a physician to determine device effectiveness in treatment of the member’s acute pain. The rental of the device may continue if medical necessity persists after the two-month rental period. TENS devices become the member’s property when the purchase price is met.

MHCP covers TENS devices for chronic pain as purchases or rentals.

Form-fitting conductive garments (E0731) are covered with authorization if one of the following criteria are met:

· The member or caregivers are unable to access the area receiving stimulation with the use of conventional electrodes, tapes, and lead wires. Documentation must include information about the availability of caregivers to assist the member; or

· The area receiving stimulation is so large or the areas so numerous that conventional electrodes, tapes, and lead wires are not practical; or

· The member has a skin condition or other medical condition that prevents the application of conventional electrodes, tapes, and lead wires.

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

One unit of 2-lead TENS supplies (A4595) is covered each month of use for members using a 2-lead TENS device (E0720). Two units of 2-lead TENS supplies are covered each month of use for members using a 4-lead TENS device (E0730).

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

Lead wires (A4557) are covered when the original item no longer functions. Document in the medical record that the original item is no longer functional. HCPCS code A4557 is not separately reimbursable within the same month of dispensing of TENS device.

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 has an end date.

Noncovered Services

MHCP does not cover the following:

· TENS devices and supplies that are not listed in this policy

· Treatment of the following indications where using TENS devices is considered investigative:

· Acute and chronic headaches

· Adhesive capsulitis (frozen shoulder)

· Carpal tunnel syndrome pain

· Chronic low back pain

· Migraines

· Phantom pain

Authorizations

Authorization is required for the following:

· Quantities over MHCP quantity limits

· Form-fitting conductive garment for delivery of TENS or NMES (E0731)

Submit authorization request and required documentation to the Medical Review Agent.

Billing

Providers are responsible to coordinate services. Refer to the Billing Policy Overview section of the MHCP Provider Manual for general billing information.

Bill TENS devices and supplies using MN–ITS 837P Professional. Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetics, Orthotics, and Augmentative Devices MN–ITS user manual for general billing requirements and guidance when submitting claims.

· Use modifier NU for purchases.

· Use modifier RR for rentals.

· Use modifiers KH, KI, KJ, and RR as appropriate for capped rentals.

· Do not bill HCPCS code A4557 within the same month of dispensing of TENS device.

· Enter the ordering provider in the Other Provider Types section of the Provider tab of the MN–ITS Interactive Claim.

· If the member has Medicare, MHCP will pay only the deductible or coinsurance on any item for which Medicare made payment, regardless of any MHCP prior authorization.

· Shipping, delivery and set-up costs are included in the MHCP maximum allowable payment and may not be separately billed to MHCP or the member.

Documentation must include:

· Member’s diagnosis and clinical history; and

· Order; and

· Areas of the body experiencing pain; and

· Description of pain intensity, including if pain is acute during post-operative period or chronic; and

· Item to be dispensed; and

· Anticipated duration of need; and

· Requested medical necessity and policy information.

Form-fitting conductive garments, lead wires, and 2-lead TENS supplies are purchase items only.

Legal References

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