LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2012-10 Coverage Reminder - TENS Used For Chronic Low Back Pain

NHIC, Corp.
DME MAC A ListServe For Immediate Release

October 19, 2012

Coverage Reminder – Transcutaneous Electrical Nerve Stimulators (TENS) Used For Chronic Low Back Pain
  • Effective for dates of service on or after June 08, 2012 TENS and related supplies used for chronic low back pain (CLBP) are only covered when the beneficiary is a participant in a CMS-approved clinical trial and has one or more required diagnoses. All other claims for TENS and related supplies used for CLBP will be denied as not reasonable and necessary. Only the following diagnoses (ICD-9) will justify coverage:
    353.4 Lumbosacral root lesions, not elsewhere classified
    720.2 Sacroiliitis, not elsewhere classified
    721.3 Lumbosacral spondylosis without myelopathy
    721.42 Thoracic or lumbar spondylosis with myelopathy – lumbar region
    722.10 Lumbar intervertebral disc without myelopathy
    722.52 Lumbosacral intervertebral disc
    722.73 Intervertebral disc disorder myelopathy – lumbar region
    722.83 Post laminectomy syndrome – lumbar region
    722.93 Other and unspecified disc disorders, lumbar region
    724.02 Spinal stenosis, lumbar region without neurogenic claudication
    724.03 Spinal stenosis, lumbar region with neurogenic claudication
    724.2 Lumbago
    724.3 Sciatica
    724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified, radicular syndrome of lower extremities
    738.4 Acquired spondylolysthesis
    739.3 Non-allopathetic lesions NEC (not elsewhere classified) – lumbar region
    756.11 Spondylosysis, lumbosacral region
    756.12 Spondylolisthesis
    805.4 Fracture of vertebral column without mention of spinal cord injury, lumbar, closed
    806.4 Fracture of vertebral column with mention of spinal cord injury, lumbar, closed
    846.0 Sprains and strains of sacroiliac region – lumbosacral (joint) (ligament)
    846.1 Sprains and strains of sacroiliac ligament
    847.2 Sprains and strains of other and unspecified parts of back, lumbar
    953.2 Injury to nerve roots and spinal plexus, lumbar root
  • The beneficiary must be enrolled in an approved clinical study that meets all of the requirements set out in NCD ยง160.27 (CMS Internet Only Manual 100-3, Chapter 1). Refer to the DOCUMENTATION REQUIREMENTS and APPENDICES sections of TENS LCD for additional information about approved clinical studies.
  • Coverage requirements for TENS and related supplies used for non-CLBP remain unchanged. Refer to the INDICATIONS AND LIMITATIONS OF COVERAGE AND/OR MEDICAL NECESSITY section of LCD for additional information about coverage for non-CLBP conditions.
  • Information concerning documentation required for TENS used for CLBP may be found in the LCD. Also Refer to the Supplier Manual for additional information about general documentation requirements.