Find-A-Code Articles, Published 2019, January 1

Transcutaneous Electrical Nerve Stimulation (TENS) Reporting

by Find-A-Code™
Jan 1st, 2019 - Reviewed/Updated Apr 15th

Explanation

A Transcutaneous Electrical Nerve Stimulator (TENS) (E0720, E0730) is a device which utilizes an electrical current delivered through electrodes placed on the surface of the skin to decrease the patient's perception of pain by inhibiting the transmission of afferent pain nerve impulses and/or stimulating the release of endorphins. A TENS unit must be distinguished from other electrical stimulators (e.g., neuromuscular stimulators) which are used to directly stimulate muscles and/or motor nerves.

It may be applied in a variety of settings, including a physician's office, the patient's home, or an outpatient clinic. Payment for TENS may be made under the Durable Medical Equipment benefit.

TENS Coding Table
Device/Unit	2 lead, localized stimulation	E0720
	4 or more leads for multiple nerve stimulation	E0730
Supplies	Conductive garment (with conductive fibers separated from patient's skin by layers of fabric)	E0731
	Conductive gel or paste, per oz	A4558
	Electrodes, per pair	A4556
	Lead wires, per pair	A4557
	Replacement batteries	A4630
	Stimulator, 2 leads, per month	A4595

TENS Unit Coding Tips

TENS units may be considered medically necessary for treatment of certain types of chronic pain (e.g., chronic musculoskeletal or neuropathic pain) which has persisted for three months or longer, is not related to other conditions (e.g., arthritis), and is unresponsive to other types of therapy (e.g., medication, ice, rest).
Some payers may cover 1 or 2 training visits where the patient is being trained to use their home device (see codes 97014, and 97032).
Face-to-Face Requirement: Medicare requires a face-to-face examination within six months prior to the order of a TENS unit. This examination must support the medical necessity requirements as outlined in the Local Coverage Determination (LCD) of your Medicare Administrative Contractor (MAC).
For Medicare, during the rental period of a TENS unit, supplies for the unit are included in the rental allowance. There is no additional allowance for electrodes, lead wires, batteries, etc. If a TENS unit (E0720 or E0730) is purchased, the allowance includes lead wires and one month’s supply of electrodes, conductive paste or gel (if needed), and batteries.

The following information from one MAC provides additional guidance on supplies for a TENS unit:

A TENS supply allowance (A4595), is an all-inclusive code and includes items such as electrodes (any type), conductive paste or gel (if needed, depending on the type of electrode), tape or other adhesive (if needed, depending on the type of electrode), adhesive remover, skin preparation materials, batteries (9 volt or AA, single use or rechargeable), and a battery charger (if rechargeable batteries are used).
Codes A4556 (Electrodes, [e.g., apnea monitor], per pair), A4558 (Conductive paste or gel), and A4630 (Replacement batteries, medically necessary TENS owned by patient) are not valid for claim submission to the DME MAC. A4595 should be used instead.
For code A4557, one unit of service is for lead wires going to two electrodes. If all the lead wires of a 4 lead TENS unit needed to be replaced, billing would be for two units of service.
There should be no billing and there will be no separate allowance for replacement electrodes (A4556), conductive paste or gel (A4558), replacement batteries (A4630), or a battery charger used with a TENS unit.
Other supplies, including but not limited to the following, will not be separately allowed: adapters (snap, banana, alligator, tab, button, clip), belt clips, adhesive remover, additional connecting cable for lead wires, carrying pouches, or covers.

- Noridian, Transcutaneous Electrical Nerve Stimulators (TENS) (Article A52520)

Form-fitting conductive garments, e.g., vest, gauntlet, etc., are often considered not medically necessary by payers, UNLESS there is a demonstrated need. The following information from Medicare provides some guidance:

A form-fitting conductive garment (and medically necessary related supplies) may be covered under the program only when:

It has received permission or approval for marketing by the Food and Drug Administration;
It has been prescribed by a physician for use in delivering covered TENS or NMES treatment; and
One of the medical indications outlined below is met:

- 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;
- 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;
- The patient has a documented medical condition such as skin problems that preclude the application of conventional electrodes, adhesive tapes and lead wires;
- The patient requires electrical stimulation beneath a cast either to treat disuse atrophy, where the nerve supply to the muscle is intact, or to treat chronic intractable pain; or
- The patient has a medical need for rehabilitation strengthening (pursuant to a written plan of rehabilitation) following an injury where the nerve supply to the muscle is intact.

A conductive garment is not covered for use with a TENS device during the trial period specified in §160.3 unless:

The patient has a documented skin problem prior to the start of the trial period; and
The A/B MAC (B)’s medical consultants are satisfied that use of such an item is medically necessary for the patient.

(See conditions for coverage of the use of TENS in the diagnosis and treatment of chronic intractable

pain in §§160.3, 160.13, and 160.27, and the use of NMES in the treatment of disuse atrophy in §150.4.)

- Medicare National Coverage Determinations Manual, Chapter 1, Part 2 Section 160.13

TENS Modifiers

The following modifiers are commonly associated with billing a TENS unit:

KX Requirements specified in the medical policy have been met

KR Rental item, billing for partial month

NU New equipment

RR Rental (use the RR modifier when DME is to be rented)

UE Used durable medical equipment

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Find-A-Code Articles, Published 2019, January 1

Transcutaneous Electrical Nerve Stimulation (TENS) Reporting

Explanation

TENS Coding Table

TENS Unit Coding Tips

TENS Modifiers

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