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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.43 Neurostimulators : 9.2.43.3 Transcutaneous Electrical Nerve Stimulation (TENS)

9.2.43.3
TENS involves the attachment of a transcutaneous nerve stimulator to the surface of the skin over the peripheral nerve to be stimulated.
TENS may be reimbursed for the treatment of acute postoperative pain or chronic pain that is refractory to conventional therapy.
TENS may be reimbursed using the following procedure codes:
 
9.2.43.3.1
Rental of a TENS device will be considered for prior authorization when there is documentation of a condition that indicates acute postoperative pain or chronic pain that is refractory to conventional therapy.
The rental of a TENS device is limited to one-month trial period with consideration for one additional month’s trial with documentation of medical necessity. Supplies, such as lead wires and electrodes, are considered to be part of the rental and will not be separately reimbursed. Garments may be considered during the rental period when medically necessary.
When the TENS device is rented for a trial period rather than supplied by the provider, the combined payment made for professional services and the rental of the stimulator must not exceed the amount which would be reimbursed for the total service, including the stimulator, if furnished by the provider alone.
9.2.43.3.2
The purchase of a TENS device is limited to once every five years and may be reimbursed with prior authorization when there is documentation of the following:

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.