TENS unit - CoxHealth

TENS unit

Is there a detailed written order prior to dispensing specifying a 2 or 4 lead TENS unit?

Yes, I have a detailed written order.

Does the patient suffer from post operative pain?

No the patient does not suffer from post operative pain.

Does your patient have chronic pain greater than 3 months that is documented in our records? Please see page 3 on Chronic Lower Back Pain*

Yes we have documentation stating that patient has had chronic pain for 3 months or greater.

Does the patient suffer from headaches, visceral abdominal pain, pelvic pain, and temporomandibular joint pain (TMJ)?

No, there is no detailed order available. To dispense the TENS unit an ABN must be signed. The ABN needs to state that no written order is available at the time of dispensing. The ABN price needs to be the total cost of the TENS unit.

Yes, the patient suffers from post operative pain.

The patient is covered for one month rental only.

Get ABN stating that the patient's diagnosis only covers one month rental. Any use after the first month will be the patient's responsibility.

No the patient does not have pain greater than three months. Get an ABN stating that the patient has not had chronic pain for greater than 3 months.

Yes one of these conditions matches up with my patient. To dispense the TENS unit an ABN must be signed stating that the specific diagnosis does not qualify the patient for the TENS unit.

No the patient does not suffer from those specific conditions.

Is there documentation stating what treatments have been tried and failed in our records? (I.E. meds, physical therapy..etc)

No there is no documentation of the past treatments.

To dispense the TENS unit an ABN must be signed stating that the patient has tried other treatments prior to the use of the TENS unit.

Yes we have documentation on file of past treatments.

The patient qualifies for a 2 month rental.

Patient needs to be re-evaluated no less than 30 days following them receiving the TENS unit by the prescribing physician.

** See Below

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MEDICARE

*Chronic Low Back Pain (CLBP)

All of the following criteria must be met for TENS therapy for CLBP

The beneficiary has one of the following ICD-9 diagnoses:

o 353.4 Lumbosacral root lesions, not elsewhere classified o 720.2 Sacroiliitis, not elsewhere classified o 721.3 Lumbosacral spondylosis without myelopathy o 721.42 Thoracic or lumbar spondylosis with myelopathy ? lumbar region o 722.10 Lumbar intervertebral disc without myelopathy o 722.52 Lumbosacral intervertebral disc o 722.73 Intervertebral disc disorder myelopathy ? lumbar region o 722.83 Post laminectomy syndrome ? lumbar region o 722.93 Other and unspecified disc disorders, lumbar region o 724.02 Spinal stenosis, lumbar region without neurogenic claudication o 724.03 Spinal stenosis, lumbar region with neurogenic claudication o 724.2 Lumbago o 724.3 Sciatica o 724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified, radicular syndrome of lower

extremities o 738.4 Acquired spondylolysthesis o 739.3 Non-allopathetic lesions NEC (not elsewhere classified) ? lumbar region o 756.11 Spondylosysis, lumbosacral region o 756.12 Spondylolisthesis o 805.4 Fracture of vertebral column without mention of spinal cord injury, lumbar, closed o 806.4 Fracture of vertebral column with mention of spinal cord injury, lumbar, closed o 846.0 Sprains and strains of sacroiliac region ? lumbosacral (joint) (ligament) o 846.1 Sprains and strains of sacroiliac ligament o 847.2 Sprains and strains of other and unspecified parts of back, lumbar o 953.2 Injury to nerve roots and spinal plexus, lumbar root.

AND

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 100-3, Chapter 1). Refer to the APPENDICES section for additional information about approved clinical studies.

There are no clinical studies that meet the above criteria in Home Supports Coverage area.

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

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Medicare Cont.

Supplies

Supplies are included with the first 2 months of rental for patients that qualify (See above).

Patient's chart must include past modalities tried for condition, RX, and re-evaluation notes for purchase month.

**Third month is considered the purchase month ? patient must have been re-evaluated and TENS proven effective

in order for Medicare to purchase TENS Unit and to pay for TENS Supplies. o For coverage of a purchase, the physician must determine that the patient is likely to derive significant therapeutic benefit from continuous use of the unit over a long period of time. The physician's records must document a reevaluation of the patient at the end of the trial period, must indicate how often the patient used the TENS unit, the typical duration of use each time, and the results.

TENS Garment

A conductive garment (E0731) used with a TENS unit is rarely reasonable and necessary, but may be covered if all of the following conditions are met:

1. It has been prescribed by a physician for use in delivering covered TENS treatment; and 2. One of the medical indications outlined below is met: 3. The patient cannot manage without the conductive garment because there is such a large area or so

many sites to be stimulated and the stimulation would have to be delivered so frequently that it is not feasible to use conventional electrodes, adhesive tapes, and lead wires; or 4. The patient cannot manage without the conductive garment for the treatment of chronic intractable pain because the areas or sites to be stimulated are inaccessible with the use of conventional electrodes, adhesive tapes, and lead wires; or 5. The patient has a documented medical condition, such as skin problems, that preclude the application of conventional electrodes, adhesive tapes, and lead wires; or 6. The patient requires electrical stimulation beneath a cast to treat chronic intractable pain. 7.

A conductive garment is not covered for use with a TENS device during the trial period unless:

1. The patient has a documented skin problem prior to the start of the trial period; and 2. The item is reasonable and necessary for the patient.

If the criteria above are not met for the garment, it will be denied as not reasonable and necessary.

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MEDICAID

TENS unit is covered through a Pre-certification for anyone under 21. TENS not covered for anyone over 21.

TENS Garment

Not covered for anyone over the age of 21 TENS garment covered through a Pre-certification for anyone under 21.

BCBS/Anthem Missouri Plans

Detailed Rx specifying 2 or 4 lead required with documentation and/or diagnosis showing medical need for TENS. On initial set-up the supplies are included All supplies can be billed after the initial set-up Out-of-State policies may require a follow-up evaluation by physician. Patient should contact their policy.

TENS Garment A garment is considered medically necessary when:

There is a large area or many sites to be stimulated that use of conventional electrodes, adhesive tapes and lead wires is not feasible; or

The areas or sites to be stimulated are inaccessible with the use of conventional electrodes, adhesive tapes and lead wires; or

There is a documented medical condition such as skin problems that preclude the application of conventional electrodes, adhesive tapes and lead wires.

UHC

Detailed Rx specifying 2 or 4 lead required with documentation and/or diagnosis showing medical need for TENS. Supplies included in the initial set-up.

TENS Garment

Detailed Rx required with documentation and/or diagnosis showing medical need for TENS garment.

CoxHealth

Detailed RX specifying 2 or 4 lead required with documentation and/or diagnosis showing medical need for TENS. Supplies are included in the initial set-up.

TENS Garment

Detailed RX required with documentation and/or diagnosis showing medical need for TENS garment.

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SUPPLIES ALLOWED

2 LEAD ? TENS UNIT

Lead Wires o 1 unit every 12 months

Electrodes & Batteries (TENS Monthly Supply) o Once a Month o 16 electrodes or 4 packages 6 AA batteries (M7 series) OR 3 9 volt batteries (Chattanooga or Cash/Carry unit) (Battery type depends on the type of unit patient has received)

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