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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 : NMES and TENS Supplies
Supplies for purchased devices are limited as follows:
Supplies are included in the rental and will not be reimbursed separately.
Supply procedure codes A4556, A4557, or A4595 may be reimbursed for clients with a purchased device and a claims history of an NMES/TENS procedure within the past five years. Providers must maintain documentation in the client’s medical record that a device has been purchased. Additional documentation such as the purchase date, serial number, and purchasing entity of the device may be required.

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