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Neurology & Pain Management Coding Alert

Pain Management:

Your 3-Step Guide to Submitting Successful TENS Claims, Despite CMS Snub

Published on Fri Jul 13, 2012

CMS stops TENS pay for most low back pain cases, but other payers might allow.

CMSannounced in June that it will no longer cover transcutaneous electrical nerve stimulation (TENS) for chronic low back pain because, "TENS is not reasonable and necessary for treatment of [chronic low back pain,]" according to a June 8,2012 memo. Other payers might reimburse providers for the use of TENs for chronic low back pain, however, so keep these tips in mind when faced with those claims.

Definition: Medicare has defined chronic low back pain (CLBP) as: An episode of low back pain that has persisted for three months or longer; and Is not a manifestation of a clearly defined and generally recognizable primary disease entity
In the memo, Medicare provides the following distinction of a primary disease manifestation: "For example, there are cancers that, through metastatic spread [...]
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