Frequently Asked Questions

Does Medicare cover TENS units and supplies?

Yes, Medicare does cover TENS units

A TENS unit is covered for medicare patients with chronic, intractable pain or acute post-operative pain when one of the following coverage criteria are met:

  1. Acute Post-operative Pain: TENS is covered for acute post-operative pain. Coverage is limited to 30 days (one month's rental) from the day of surgery. Payment will be made only as a rental. A TENS unit will be denied as not reasonable and necessary for acute pain (less than three months duration) other than for post-operative pain.
  2. Chronic Pain Other than Low Back Pain: TENS is covered for chronic, intractable pain other than chronic low back pain when all of the following criteria must be met:
    • The presumed etiology of the pain must be a type that is accepted as responding to TENS therapy. Examples of conditions for which TENS therapy is not considered to be reasonable and necessary are (not all-inclusive):
      • headache
      • visceral abdominal pain
      • pelvic pain
      • temporomandibular joint (TMJ) pain
    • The pain must have been present for at least three months.
    • Other appropriate treatment modalities must have been tried and failed.

A separate allowance will be made for replacement supplies when they are reasonable and necessary and are used with a covered TENS. Usual maximum utilization is:

  • 2 TENS leads - a maximum of one unit of A4595 per month.
  • 4 TENS leads - a maximum of two units of A4595 per month.

Reimbursement for supplies is contingent upon use with a covered TENS unit. Claims for TENS supplies provided when there is no covered TENS unit will be denied as not reasonable and necessary.

Does insurance cover TENS units and supplies?

Most insurance companies cover TENS Units and supplies for chronic pain when the pain causes significant disruption of function, and pain is unresponsive to at least three months of conservative medical therapy, including nonsteroidal anti-inflammatory medications, ice, rest, and/or physical therapy.

What is a TENS unit?

TENS stands for “Transcutaneous Electrical Nerve Stimulation”, a non-invasive drug free method for controlling pain. TENS consists of a device that transmits low-level electrical impulses into the part of your body experiencing pain.

How do TENS units work?

TENS is a therapy that uses low voltage electrical current to provide pain relief. A TENS unit consists of a battery-powered device that delivers electrical impulses through electrodes placed on the surface of your skin. The electrodes are placed at or near nerves where the pain is located or at trigger points.

There are two theories about how TENS works.

    • One theory is that the electric current stimulates nerve cells that block the transmission of pain signals, modifying your perception of pain.
    • The other theory is that nerve stimulation raises the level of endorphins, which are the body’s natural pain-killing chemical. The endorphins then block the perception of pain.

What conditions do TENS units treat?

  • Arthritis
  • Fibromyalgia
  • Tendinitis
  • Bursitis
  • Labor pain
  • Low back pain
  • Pelvic pain
  • Period pain
  • Joint pain
  • And more…

Who can use TENS units?

Any adult who suffers from muscle or joint pain can use this therapy. Ask your physician if you have any questions related to your health.

Many studies suggest that TENS can used during pregnancy to relieve low back pain. It is a safe and effective treatment. Before starting any TENS treatment plan, please consult with your physician.

You should not use a TENS unit if you:

  • Have a pacemaker or defibrillator
  • Have a spinal cord stimulator
  • Have in-dwelling pumps or monitors
  • Have any implanted metallic or electronic device
  • Have epilepsy

Do I need a prescription for a TENS unit?

Insurance Covered TENS Units provides two different options for TENS therapy.  The Intensity 10 TENS device is a prescription only device, so it requires a prescription from your doctor for insurance to consider coverage.  The Intensity at Home TENS is an over the counter device that can be purchased without having a prescription from your doctor.

What needs to be documented in my medical record by my doctor?

For chronic pain there must be information in the medical record describing:

  • The location of the pain
  • The severity of the pain
  • The duration of time the beneficiary has had the pain
  • The presumed etiology of the pain
  • Prior treatment and results of that treatment
  • Reevaluation of the beneficiary at the end of the trial period, must indicate
    • How often the beneficiary used the TENS unit
    • The typical duration of use each time
    • The results (effectiveness of therapy)

When can I get new lead wires?

Typically lead wires are replaced once a year.

Medicare allows replacement of lead wires once every 12 months. If lead wires need to be replaced more frequently, you may be responsible for the cost of additional lead wires.