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Medicare Eligible TENS/NMES Devices

Are you eligible to receive a transcutaneous electrical nerve stimulation (TENS) device that is covered by insurance? TENS/NMES equipment is covered under the Durable Medical Equipment benefit of the Social Security Act for beneficiaries who meet eligibility requirements. Please read the requirements below and fill out the eligibility form to see if you qualify for reimbursement for your TENS/NMES device.

Get on track to better pain treatment with TENS/NMES devices from HiDow International.

 

When Is My Device Covered by Insurance?

Any item, including transcutaneous electrical nerve stimulation (TENS) devices, must meet the following criteria to be covered by Medicare:

  1. Be eligible for a defined Medicare benefit category.
  2. Be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and
  3. Meet all other applicable Medicare statutory and regulatory requirements.

Transcutaneous electrical nerve stimulation (TENS/NMES) equipment is covered under the Durable Medical Equipment benefit (Social Security Act §1861(s)(6)).

 

Which Conditions Qualify for Muscle-Stim Eligibility?

Because some insurances will cover the use of a TENS/NMES device for pain treatment under this program, patients must first qualify based on a diagnosis from their physician. Speak with your doctor to see if a TENS/NMES unit is right for treating your pain condition.

A TENS/NMES is covered for the treatment of beneficiaries with intractable pain or acute post-operative pain, muscular asymmetry, and atrophy when one of the following coverage criteria, I-III, are met:

  • Acute Post-Operative Pain

TENS/NMES is covered for acute postoperative pain. Coverage is limited to 30 days (one month’s rental) from the day of surgery. Payment will be made only as a rental.

A TENS/NMES unit will be denied as not reasonable and necessary for acute pain (less than three months duration) other than for post-operative pain.

  • Pain Other than Low Back Pain
    TENS/NMES is covered for intractable pain other than low back pain when all of the following criteria must be met:
  • The presumed etiology of the pain must be a type that is accepted as responding to TENS/NMES therapy. Examples of conditions for which TENS/NMES therapy is not considered to be reasonable and necessary are (not all-inclusive):
  • Visceral abdominal pain
  • Pelvic pain
  • Temporomandibular joint (TMJ) pain
  • Headache
  • The pain must have been present for at least three months.
  • Other appropriate treatment modalities must have been tried and failed.

TENS/NMES therapy for pain that does not meet these criteria will be denied as not reasonable and necessary.

  • Low Back Pain (CLBP)
    TENS/NMES therapy for CLBP is only covered when all of the following criteria are met:
  • The beneficiary has one of the diagnosis codes listed. (Refer to the ICD-10 code list in the LCD-related Policy Article for applicable diagnoses.)
  • The beneficiary is enrolled in an approved clinical study that meets all of the requirements set out in NCD §160.27 (CMS Internet-Only Manual 100-03, Chapter 1). Refer to the APPENDICES section for additional information about approved clinical studies.

TENS/NMES therapy for CLBP that does not meet these criteria will be denied as not reasonable and necessary.

Note: Must not have received a device within the past 5 years. If one was received in the past 5 years, then it must be documented by the physician as lost, stolen, or broken and non-repairable.

 

I Believe I am Eligible. What next?

If you meet the criteria listed above and in the accompanying documentation, please fill out the form below. We will reach out to you shortly with information regarding your Medicaid-covered TENS/NMES device.

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