BlueCross BlueShield of Tennessee Medical Policy Manual

Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)


Percutaneous electrical nerve stimulation (PENS) is an electronic stimulus generator that transmits electrical impulses of various configurations to a needle electrode that is inserted just below the skin for the purpose of pain management. PENS is distinguished from acupuncture with electrical stimulation. In electrical acupuncture, needles are also inserted just below the skin, but the placement of needles is based on specific theories regarding energy flow throughout the human body. In PENS, the location of stimulation is determined by proximity to the pain rather than the theories of energy flow that guide placement of stimulation for acupuncture.

Needle electrodes are inserted either around or immediately adjacent to the nerves serving the painful area and are then stimulated. PENS is proposed as an alternative for individuals who fail to get pain relief from TENS possibly due to physical barriers (e.g., scar tissue, obesity) to the conduction of electrical stimulus. PENS units, which are usually battery operated, have been investigated as a means to relieve chronic intractable pain, post-surgical pain and pain associated with traumatic injuries unresponsive to other standard pain therapies. The mechanism of action is unknown, but it is purported that the electrical pulses block the transmission of pain to nerve fibers or may stimulate the release of endorphins or serotonin.

Percutaneous neuromodulation therapy (PNT) is a variant of PENS in which fine filament electrodes are temporarily placed at specific anatomic landmarks in the deep tissues near the area of the spine that is causing pain (with or without radiating lower extremity pain). Treatment regimens consist of 30-minute sessions, once or twice a week for 8 to 10 sessions.


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The literature for percutaneous electrical nerve stimulation (PENS) and percutaneous neuromodulation therapy (PNT) consists primarily of small controlled trials with unclear blinding and short follow-up.  The available evidence is insufficient to permit conclusions concerning the effect of this procedure on health outcomes.


American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Academy of Physical Medicine & Rehabilitation. (May, 2011). Evidence-based guideline: treatment of painful diabetic neuropathy. Retrieved March 30, 2016 from the National Guideline Clearinghouse (NGC: 008504).

American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine. (2010). Practice guidelines for chronic pain management: An updated report by the American Society of Anesthesiologists task force on chronic pain management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology, 112 (4), 810-833.

BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2015). Percutaneous electrical nerve stimulation and percutaneous neuromodulation therapy (7.01.29). Retrieved February 1, 2017 from BlueWeb. (21 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. National Coverage Determination: NCD for assessing patient’s suitability for electrical nerve stimulation therapy (160.7.1). Retrieved March 30, 2016 from

National Institute for Health and Care Excellence. (2013, March). Interventional procedure guidance: Percutaneous electrical nerve stimulation for refractory neuropathic pain. Retrieved February 1, 2017 from

National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Diabetic neuropathies: the nerve damage of diabetes. Retrieved March 30, 2016 from

Rossi, M., DeCarolis, G., Liberatoscioli, G., Iemma, D., Nosella, P., & Nardi, L.F. (2016). A novel mini-invasive approach to the treatment of neuropathic pain: the PENS study. Pain Physician, 19 (1), E121-E128. Abstract retrieved March 30, 2016 from PubMed database.

U.S. Food and Drug Administration. (2005, December) Center for Devices and Radiologic Health. 510(k) Premarket Notification Database K052289. Retrieved December 12, 2011 from:

U.S. Food and Drug Administration. (2006, August) Center for Devices and Radiologic Health. 510(k) Premarket Notification Database K061166. Retrieved December 12, 2011 from:




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