HCPCS E0720 and E0730 — Transcutaneous Electrical Nerve Stimulation (TENS) Devices

Transcutaneous Electrical Nerve Stimulation (TENS) Devices, HCPCS E0720 and E0730, are challenging items to get paid. According to recent information from RemitDATA, TENS units have a 42.9 percent denial rate. That means nearly half of all claims that are submitted are getting denied. Why is that? The No. 1 denial code for TENS is CO108 - Rent/purchase guidelines were not met. The No. 2 denial is CO50 - These are non-covered services because this is not deemed a “medical necessity” by the payer.

There are specific rules within the medical policy regarding the rental and purchase of a TENS device that both intake and billing personnel must be aware of. Without this knowledge, claims will be sent without meeting the rent-to-purchase guidelines. A TENS must be used for a trial (rental) period before the purchase can be made.

There are two scenarios under which a TENS would be prescribed in Medicare's eyes: 1) for acute post-operative pain, and 2) for chronic pain. A written order prior to delivery (WOPD) must be obtained before dispensing the TENS. The WOPD is a signed written order from the physician.

A Certificate of Medical Necessity (CMN) is required for the purchase of the TENS after the trial/rental period is complete. Additionally, there must be specific documentation regarding the pain in the patient's medical record (narrative notes from the physician, home health agency, nurses, physical therapists, occupational therapists, etc.). Prior to submitting the claim for purchase, make sure the rental has been paid. Medicare will not pay for the purchase if the program has not paid for the rental.

When a TENS unit is used for acute post-operative pain, the medical necessity is usually limited to 30 days from the day of surgery. 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.

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 exceeding 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 the pain.