A question about a Tens unit and medicare

Discussion in 'Chit Chat' started by ckball, Apr 16, 2007.

  1. ckball

    ckball New Member

    Hi everyone,

    Does medicare pay for a Tens unit. What do you use your tens unit for? I understand that it helps different people with other dxs.

    My problem is mid and upper back scolosis. While my health has improved, hence the reason I haven't been posting alot. I have been very busy getting things done. But my mid & upper back is getting to be unbearable. My pain meds help my other joint pain (RA) but nothing helps the back pain. Especially when I am doing my stained glass, just having to hold my arms out in front of me is a killer.

    I just have to sit or lay down when I don't feel like it just to get some releif. I have an appt next week with my Dr and want to discuss it with her. I appreciate any input you have. Thanks, Carla
  2. ckball

    ckball New Member

    Thank you for the info, it sounds like one of those things the chiropractor uses before they adjust you.

    I was hoping for more responses on how others use theirs and if medicare pays for it.

    I hope your insurance takes care of yours-Carla
  3. lilaclover30

    lilaclover30 New Member

    ppaid for minje. I hate to say that I haven't used it in a while. Guess i will go and have hubby8 help me put it on.

    Gentle hugs
  4. mezombie

    mezombie New Member

    Medicare will cover the cost of a TENS machine under certain conditions. Your doctor definitely needs to state this is medically necessary.

    Check out the following site which explains how to get Medicare to pay for this. I suspect it will answer your questions.

    http://www.empi.com/products/tens/medicare.pdf

    [This Message was Edited on 04/17/2007]
  5. ckball

    ckball New Member

    Sorry it has taken me so long to get back. My puter is on the frtiz, Thanks fo the link, I tryed to go there my puter said no, so I will try again today.

    Now can anyone fix my IE7, lol-Have a great day-Carla

  6. mezombie

    mezombie New Member

    So sorry to hear your computer is on the fritz. My printer keeps acting up, but I suspect that's because one of my two cats likes to sit on it, LOL!

    I've copied and pasted most of the info you weren't able to accesss. Sorry for the formating!

    EDIT: I've since learned that Medicare has recently revised its policies, and you don't need authorization for the TENS rental (despite what it says below). You still need it for a purchase. It's very confusing. Hopefully your doc's billing person will know more about this. CMS Form 848 seems to be the critical document that has to be filed somewhere along the line.

    The bottom line is that Medicare will pay for a TENS unit.

    -----------------------------------------------------------
    Medicare Guidelines for TENS

    Introduction

    Medicare has very specific guidelines covering the use of
    Transcutaneous Electrical Nerve Stimulation (TENS) in
    treating pain conditions.

    What are the requirements of the
    prescribing physician?

    The requirements are detailed in the Medicare MEDMANUAL.
    Relevant excerpts on coverage and payment rules follow.

    Coverage and payment rules

    “A Transcutaneous Electrical Nerve Stimulator (TENS) is
    covered for the treatment of patients with chronic,
    intractable pain or acute post operative pain who meet
    the coverage rules listed below.
    “When a TENS unit is used for acute post-operative pain,
    the medical necessity is usually limited to 30 days rental
    from the day of surgery. A payment for more than one
    month is determined by individual consideration based
    on supportive documentation provided by the attending
    physician. Payment will be made only as a rental. A
    TENS unit will be denied as not medically necessary for
    acute pain (less than three months) duration other than
    post-operative pain.
    “For chronic pain, the medical record must document
    the location of the pain, the duration of time the patient
    has had the pain, and the presumed etiology of the pain.
    The pain must have been present for at least three
    months. Other appropriate treatment modalities must
    have been tried and failed, and the medical record must
    document what treatment modalities have been used
    (including the names and dosages of medication), the
    length of time each type of treatment used, and the
    results.
    “The presumed etiology of pain must be a type accepted
    as responding to TENS therapy. Examples of conditions
    for which a TENS unit are not considered to be
    medically necessary are headache, visceral abdominal
    pain, pelvic pain, and TMJ pain.” 1

    Why two CMNs may be required
    for TENS?

    When a Medicare patient is using the TENS device for
    chronic pain, a trial period (rental) is required. The first CMN is needed for the trial. A second CMN is required prior to approval of the purchase of a TENS device. The prescribing physician must reevaluate the patient at the end of the trial period (30-60 days) and document that the device is medically necessary.

    What is required in the trial CMN?

    “When used for the treatment of chronic, intractable
    pain, the TENS unit must be used by the patient on a
    trial basis for a minimum of one month (30 days), but
    not to exceed two months. The trial period will be paid
    as a rental. The trial period must be monitored by the
    physician to determine the effectiveness of the TENS
    unit in modulating pain.” 1
    Physician (or non-physician clinician, or physician
    employee, if reviewed and signed by prescribing
    physician) must complete the following questions in
    Section B and sign and date the CMN: Length of Need,
    ICD-9 Codes, and Questions 1-6 and 12. A reevaluation
    with the prescribing physician is required following a
    one month (30 days minimum) to two month (60 days
    maximum) trial period.

    What is required in the purchase CMN?

    “For coverage of a TENS purchase, the physician must
    determine that the patient is likely to derive significant
    therapeutic benefit from the continuous use of the unit
    over a long period of time. The physician's records
    must document a reevaluation of the patient at the end
    of the trial period, must indicate how often the patient
    used the TENS unit, the typical duration of use each
    time, and the results.” 1
    Physician (or non-physician clinician, or physician
    employee, if reviewed and signed by prescribing
    physician) must complete the following questions in
    Section B and sign and date the CMN: Length of Need,
    ICD-9 Codes, and Questions 3-12.
    1 MED-MANUAL, MED-GUIDE, MEDICAL POLICY SUBJECT:
    Transcutaneous Electrical Nerve Stimulators (TENS), COPYRIGHT
    1998, CCH Incorporated.

    What is required on the prescription?

    The prescription must be written on the physician's
    personalized pad and include the following
    information:
    • Patient's name
    • Description of item
    • Physician's signature
    • Date the physician signed the prescription
    As with a CMN, signature and date stamps are not
    allowed. The date of the prescription must be on or
    before the issuance date of the TENS device.
    Empi Medicare Services 1-800-328-2536
    U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES
    HEALTH CARE FINANCING ADMINISTRATION
    FORM APPROVED
    OMB NO. 0938-0679
    CERTIFICATE OF MEDICAL NECESSITY DMERC 06.02B
    TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR (TENS)
    SECTION A Certification Type/Date: INITIAL ___/___/___ REVISED ___/___/___
    PATIENT NAME, ADDRESS, TELEPHONE and HIC NUMBER SUPPLIER NAME ADDRESS, TELEPHONE and NSC NUMBER
    (__ __ __) __ __ __ - __ __ __ __ HIC #________________________________ (__ __ __) __ __ __ - __ __ __ __ NSC #___________________________________
    PLACE OF SERVICE _______
    NAME and ADDRESS of FACULTY if appropriate
    (See Reverse)
    HCPCS CODE
    ____________
    ____________
    ____________
    ____________
    PT DOB ___/___/___; Sex____(M/F); HT.____(in.); WT.____(lbs.)
    PHYSICIAN NAME, ADDRESS (Printed or Typed)
    PHYSICIAN’S UPIN:______________________________
    PHYSICIAN’S TELEPHONE #: (__ __ __) __ __ __ - __ __ __ __
    SECTION B Information in this Section May Not Be Completed by the Supplier of the Items/Supplies.
    EST. LENGTH OF NEED (# OF MONTHS): ______ 1-99 (99 = LIFETIME)
    ANSWERS ANSWER QUESTIONS 1-6 FOR RENTAL OF TENS, AND 3-12 FOR PURCHASE OF TENS.
    (Circle Y for Yes, N for No, or D for Does Not Apply, Unless Otherwise Noted)
    Y N D 1. Does the patient have acute post-operative pain?
    Y N D 3. Does the patient have chronic, intractable pain?
    Y N D 6. Is there documentation in the medical record of multiple medications and/or other therapies that have been tried and failed.
    Began/Ended
    ___/___/___
    ___/___/___
    8. What are the dates that trial of TENS unit gena and ended?
    ___/___/___ 2. What is the date of surgery resulting if acute post-operative pain?
    (___ months) 4. How long has the patient had intractable pain? (Enter number of months, 1 - 99.)
    1 2 3 4 5
    5. Is the TENS unit being prescribed by any of the following conditions? (Circle appropriate number)
    1 - Headache 2 - Visceral abdominal pain 3 - Pelvic pain
    4 - Tempomandibular joint (TMJ) pain 5 - None of the above
    ___/___/___ 9. What is the date you reevaluated the patient at the end of the trial period?
    1 2 3
    10. How often has the patient been using the TENS? (Circle appropriate number)
    1 = Daily 2 = 3 to 6 days per week 3 = 2 or less days per week
    2 4 12. Number of TENS leads (i.e., separate electrodes) routinely needed and used by the patient at any one time.
    (Circle appropriate number) 2 = 2 leads 4 = 4 leads
    11. Do you and the patient agree that there has been a significant improvement in the pain and that long term use of a TENS is warranted?
    NAME OF PERSON ANSWERING SECTION B QUESTIONS, IF OTHER THAN PHYSICIAN (Please Print):
    NAME:_______________________________________________ TITLE:____________________________ EMPLOYER:_______________________________________
    SECTION C Narrative Description Of Equipment And Cost
    (1) Narrative description of all items, accessories and options ordered; (2) Supplier’s charge; and (3) Medicare Fee Schedule Allowance for each item, accessory, and option.
    (See Instructions On Back)
    SECTION D Physician Attestation and Signature/Date
    I certify that I am the physician identified in Section A of this form. I have received Sections A, B and C and the Certificate of Medical Necessity (including changes
    for times ordered). Any statement on my letterhead attached therein, has been received and signed by me. I certify that the medical necessity information in Section
    B is true, accurate and complete, to the best of my knowledge, and I understand that any falsification, omission, or concealment of material fact in that section may
    subject me to civil or criminal liability.
    PHYSICIAN’S SIGNATURE _________________________________________ DATE ___/___/___ (SIGNATURE AND DATE STAMPS ARE NOT ACCEPTABLE)
    Accurate completion of the CMN is critical to successful coverage.
    TRIAL and PURCHASE. Complete colored items directly on the form. The CMN must be signed and dated by prescribing
    physician in original ink. Medicare does not allow signature stamps or date stamps. If the CMN is altered the prescribing
    physician must circle or put a slash (/) through the error, sign in full and date the correction. Correction fluid is not allowed.
    802130 Rev. A. ©1999 Empi, Inc. 6/99

    [This Message was Edited on 04/18/2007]