1.0 DESCRIPTION
A TENS device is a small, wearable,
battery-operated device that uses electrical impulses to relieve
pain. TENS is a non-invasive technology that involves the application
of adhesive electrodes to the skin at painful parts of the body.
TENS devices may have one electrode with two lead wires that connect
the electrode to the device, or two electrodes with four lead wires
that connect the electrodes to the device. TENS may be administered
by a clinician in a hospital or outpatient setting, or self-administered
by a beneficiary at home. Over-the-counter TENS units are widely
available for purchase.
3.0 REPLACEMENT
SUPPLIES
3.1 For TENS units with two leads:
3.1.1 A maximum
of one unit of replacement supplies (A4595, i.e., electrodes; conductive
paste/gel; tape or other adhesives; adhesive remover; skin preparation
materials; batteries; and battery chargers) is covered per month,
not to exceed 90 days (three months); and
3.1.2 A maximum
of one unit of replacement leads (A4557) is covered per episode
of care, not to exceed 90 days (three months) from the day of the
surgery.
3.2 For TENS units with four leads:
3.2.1 A maximum
of two units of replacement supplies (A4595, i.e., electrodes; conductive
paste/gel; tape or other adhesives; adhesive remover; skin preparation
materials; batteries; and battery chargers) is covered per month,
not to exceed 90 days (three months); and
3.2.2 A maximum
of two units of replacement leads (A4557) is covered per episode
of care, not to exceed 90 days (three months) from the day of the
surgery.
3.3 Conductive garments for the
delivery of TENS (E0731) are covered only if all of the following
conditions are met:
3.3.1 A TRICARE authorized provider
has prescribed the garment for use in delivering covered TENS treatment;
and
3.3.2 The beneficiary has a documented
skin condition which precludes the use of conventional electrodes, adhesive
tapes, and lead wires; or
3.3.3 The beneficiary
cannot receive treatment without a conducive garment because:
• There is a large area or many
sites to be stimulated, making the use of conventional electrodes,
adhesive tapes, and lead wires impracticable; or
• The stimulation must be delivered
so frequently that the use of conventional electrodes, adhesive
tapes, and lead wires is impracticable.
4.0 EXCLUSIONS
4.1 Effective
June 1, 2020, TENS devices and supplies for home use, prescribed
during the course of physical therapy, for the treatment of acute,
subacute, and chronic low back pain (LBP) are excluded. See
Chapter 7, Section 18.2 for physical therapy
that includes the use of TENS treatment.
4.2 Effective
July 1, 2026, TENS devices and supplies for the treatment of chronic
post-operative pain are excluded.
4.3 Effective
July 1, 2026, TENS devices and supplies are excluded for the treatment
of all conditions not listed under
paragraph 2.1.
