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.
Full Answer
Is TENS therapy covered by Medicare?
The lack of strong evidence in support of TENS may explain why, in 2012, the Centers for Medicare & Medicaid Services (CMS), announced that Medicare benefits would no longer cover TENS treatments for chronic lower back pain, stating that it is not a reasonable and necessary treatment for this condition.
What are the payment policy requirements for a TENS unit?
In addition, there are specific statutory payment policy requirements, discussed below, that also must be met. During the rental of a TENS unit, supplies for the unit are included in the rental allowance; there is no additional allowance for items such as electrodes, lead wires, and batteries.
Who can order a TENS unit?
The practitioner ordering the Transcutaneous Electrical Nerve Stimulators (TENS) unit and related supplies must be the treating practitioner for the disease or condition justifying the need for the TENS unit.
Can a TENS unit be used for chronic low back pain?
TENS therapy for Chronic Low Back Pain (CLBP) will be denied as not reasonable and necessary. When used for the treatment of chronic, intractable pain described in section II, the TENS unit must be used by the beneficiary on a trial basis for a minimum of one month (30 days), but not to exceed two months.
What is the format required by CMS for electronic claim submission?
What are the 837P and Form CMS-1500? The 837P (Professional) is the standard format used by health care professionals and suppliers to transmit health care claims electronically. The Form CMS-1500 is the standard paper claim form to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed.
What are the documentation guidelines for DME?
Documentation, including pertinent portions of the beneficiary's medical records (e.g., history, physical examination, diagnostic tests, summary of findings, diagnoses, treatment plans), supporting the medical necessity of the prescribed PMD must be furnished to the supplier within 45 days of the examination.
What must be on the valid detailed written order?
A detailed written order (“DWO”) must be obtained prior to billing a claim to Medicare. A DWO must contain the following: name of the beneficiary; date of the order; and a description of the items (by HCPCS code narrative or brand name/model number).
How do I submit a DME claim to Medicare?
Contact your doctor or supplier, and ask them to file a claim. If they don't file a claim, call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048. Ask for the exact time limit for filing a Medicare claim for the service or supply you got.
What is the criteria for documentation of medical necessity?
Well, as we explain in this post, to be considered medically necessary, a service must: “Be safe and effective; Have a duration and frequency that are appropriate based on standard practices for the diagnosis or treatment; Meet the medical needs of the patient; and.
How do you write DME order?
Standardized DMEPOS Written Order/PrescriptionBeneficiary name or Medicare Beneficiary Identifier (MBI) Number.Description of the item.Quantity, if applicable.Treating practitioner name or National Provider Identifier (NPI)Date of the order.Treating practitioner signature.
What is standard written order?
Standard Written Order (SWO) All claims for items billed to Medicare require a written order/prescription from the treating practitioner as a condition for payment. This written order/prescription is referred to as the Standard Written Order (SWO). / Beneficiary's name or Medicare Beneficiary Identifier (MBI)
How do you write a DME script?
Your prescription can be handwritten on a standard prescription pad. It must include the physician's name, contact information and signature of the care provider; your name; and a statement about the equipment needed, for example "Oxygen at LPM" “CPAP” , “BiPAP”, “CPAP Mask”, “CPAP Humidifier” or “CPAP Supplies”.
What is a 5 element order?
The 6407- required order is referred to as a five-element order (5EO). The 5EO must meet all of the requirements below: The 5EO must include all of the following elements: Beneficiary's name. Item of DME ordered - this may be general – e.g., "hospital bed"– or may be more specific.
What is modifier RR?
Categories for using common modifiers Use modifiers RR, NU and UE for the following categories: Capped rental item. Oxygen equipment without contents. Items that require frequent and substantial servicing. Routinely purchased items or inexpensive ones.
What is a Medicare DME claim?
covers. medically necessary. Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. DME if your doctor prescribes it for use in your home.
What is the ICD 10 code for durable medical equipment?
Claims for DME for a disabled parent must be submitted using HCPCS code A9999 (miscellaneous DME supply or accessory, not otherwise specified), ICD-10-CM diagnosis code Z73. 6 and modifier SC.
What Is a TENS Unit?
TENS stands for transcutaneous electrical nerve stimulator. A TENS device may be used to treat chronic pain for a wide range of medical conditions or physical therapy. The device is used to target muscles in the body, such as those that are healing or are experiencing chronic pain.
How Much Does a Good TENS Unit Cost?
The cost of a TENS unit may vary depending on the model, its capabilities and any additional functions. The cheaper units may run around $100, but more expensive models can be over $500.
Can a Doctor Prescribe a TENS Unit?
Yes, a doctor can and might prescribe a TENS unit for you if there is considerable evidence that it's needed. Because your Medicare or Medicare Advantage plan may only cover certain devices, it's important that you review your coverage with your physician before receiving the prescription.
Does Medicare Cover TENS Units for Back Pain?
Most of the evidence and research about TENS units has been anecdotal in regards to how effective a TENS unit is in the treatment of back pain. For this reason, Medicare may deny coverage on the grounds that your doctor is not exploring other avenues for your treatment.
Does Medicare Cover TENS Units for E-Stim Therapy?
There are many conditions that may require e-stim therapy, which requires the use of a TENS unit. If your doctor is using a broader approach that incorporates the use of your device as part of a larger treatment plan, you're more likely to be approved for coverage.
What TENS Units Are Covered by Medicare?
If you have received approval from Original Medicare (Medicare Part A and Part B) or from a Medicare Advantage plan for the use of a TENS unit, it will be covered under your medical devices coverage. You will need to work with your doctor to find a specific device that your plan covers.
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Coverage Guidance
For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
How long is a DMEPOS supply?
Most DMEPOS accessory/supply items provided on a recurring basis can be dispensed with a three month supply. Those include, but are not limited to, PAP or RAD accessories, nebulizer inhalation medication, urological supplies, and ostomy supplies.
How many months to bill PAP?
When billing more than one month's supply of these items, include a narrative in the NTE segment of the electronic claim indicating the number of months you are billing. If you bill a three month supply of PAP accessories (i.e., mask, tubing, cushions), simply add "90 days" or "three months".
What are the requirements for DMEPOS?
Additionally, CGS has seen a spike in the number of claims that have been rejected for lack of date spans on claims. As a reminder, the following DMEPOS items require a date span on all claims submitted to the DME MACs: 1 Diabetic testing supplies (i.e., test strips, lancets) 2 Continuous passive motion devices (CPM) 3 Parenteral and enteral nutrition 4 Parenteral and enteral administration kits 5 External infusion pump supplies (recommended)
How long can you keep IVIG?
There are a few exceptions to the three-month maximum rule. Only a one-month quantity of supplies may be dispensed for the following: Surgical dressings. Enteral and parenteral nutrients and supplies. Immunosuppressive drugs. Oral Anticancer Drugs. Oral Antiemetic Drugs. Intravenous Immune Globulin (IVIG)
What are functional activities for Medicare?
Some functional activities include bending, lifting, carrying, reaching, catching and overhead activities. The activities should be targeted at a loss or restriction of mobility, strength, balance or coordination.
What is the CPT code for therapeutic exercise?
Therapeutic Exercises (CPT Code: 97110 ) One of the core therapy treatment codes, 97110 requires the following documentation to support a billed unit. Medicare notes that often you will bill multiple units of 97110 on one claim.
What is a POC in medical?
Medicare Plan of Care (POC) Requirements. Medicare clearly states their requirements for developing a plan of care, which is required for any therapy visit to be covered. The plan must be reviewed and signed by the referring physician. The therapist may not significantly alter the POC without approval by the referring physician.
What is the CPT code for neuromuscular reeducation?
Neuromuscular Re-Education (CPT Code: 97112 ) Medicare notes that this procedure is provided to improve balance, coordination, kinesthetic sense, posture, and proprioception and that the procedure may be reasonable and necessary for impairments that affect the body’s neuromuscular system.
What is the CPT code for e-stim?
CPT Code 97032 also requires direct (one-on-one) patient contact by a qualified professional and clear documentation of the type of electrical stimulation provided, as well as the medical necessity of constant contact. Types of e-stim that might require constant contact include:
How long does a POC have to be recertified?
The plan must be re-certified by the physician within the duration of the initial POC or within 90 calendar days of the initial treatment, whichever is less.
Why is it important to document therapeutic exercises?
Documentation must show how these therapeutic exercises are helping the patient progress towards their stated, objective and measurable goals. The exercise is reasonable and necessary if it is performed for the purpose of restoring functional strength, range of motion, endurance training, and flexibility.