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Transcutaneous Electrical Nerve Stimulation (TENS) Procedure Code E0736 to Become a Benefit Effective May 1, 2024

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after May 1, 2024, transcutaneous electrical nerve stimulation (TENS) procedure code E0736 will become a Medicaid benefit with prior authorization for clients who are 18 years of age or older.

TENS is for the treatment of overactive bladder (OAB) and will be limited to clients who have had the following:

  • An evaluation that has been performed by an appropriate specialist, usually a urologist or urogynecologist, who has determined that the client is a candidate for posterior tibial nerve stimulation (PTNS)
  • A medical record that includes the following documentation:
    • The client has been compliant with and has failed a trial of symptom-appropriate behavioral therapy of sufficient length to evaluate potential efficacy.
    • The client has been compliant with and has failed or been unable to tolerate a trial of at least two appropriate medications administered for four to eight weeks.
    • The client’s voiding diary shows continued findings of OAB.
    • The client has documented a willingness to attend in-office treatment sessions, to comply with behavioral therapies, and to continue to keep voiding diaries that include documentation of behavioral therapy compliance.

For more information, call the TMHP Contact Center at 800-925-9126.